The Curative Effect Analysis For Treatment Of Unstable Distal Radus Fractures With Wrist Span Joint External Fixator

Objective: Distal radius fractures are the most common fractures of theupper limbs，which accounts for about17%of the whole body bone fracture.Although beginning of the Pouteau, Colles etc, this fracture hasbeenresearchedmore than200years, but recent the larger series clinical analysis shows that:distal radius fractures is still a in a variety of forms damage, forward curativeeffect is not very exact complex fractures. The complexity of the fracture andfunction are not satisfied,because of the main determinants in distal radiusarticular surface unique anatomy structure, function learning requirements,and the correlation of fracture and the surrounding of the jointligamentdamage. After the occurrence of fractures,the major clinicalmanifestations is that the activities limited wrist flexion and extension,swelling, pain and deformity. Distal radius fracture is a common clinicalmultiple fractures,and if it is incorrect treatment, which easy to cause carpaltunnel in chronic pain and stiffness, and affect the function of hand. So thechoice of treatment for distal radius fractures is particularly important. Theultimate goal is the outcomethat stable fractures, maintain a reset, restore thearticular surface smoothly, wrist joint normal anatomic relationship; Includingradial length, inclination angle, foot Angle, radiocarpal joint, ulnar carpaltunnel and ulnar radial joints, etc, and And exercise early，reducing thecomplications to improve patient quality of life or to return to work. Atpresent the clinical that the distal radius fractures generally were divided intotwo types, stable and unstable. More commonly used for distal radial stablefracture is non-surgical treatment, such as the external fixation of plaster orsmall splint fixation which can achieve the desired results. But for unstablefracture, especially involving the articular surface fracture shift, due to thelack of supporting bone cortex local stability is poor, compression cancellous bone defect, and joint surface subsidence, soft tissue damage is severe,causing unstable fractures, hard reset or easy to shift again after reset, so theconservative treatment can be difficult. External fixation support clinicalapplications has been years of history, rely on reconstructive action to offsetthe forearm muscles ligament fractures caused by displacement oftraction,which can better restore radial shortening shift, and external fixatorsurgical operation is simple, both to ensure the blood supply of the fracture,and reduced the wrist joint soft tissue damage and interference, and to allowearly functional exercise.In order to compensate for the disadvantages of bonedefect and fixed and reliable enough, most scholars have proposed that localneedle was combined with bone graft and fixation.This paper studies the dataof distal radius fractures preoperative and postoperative which related, and toanalyze the treatment effect of an unstable distal radius fracture with externalfixator span joint treatment.Methods: From October2010to October2012,72(76sides) cases distalradius fractures were treated with the span joint external fixator of handsurgery department third hospital Hebei medical university.including4casesopen fractures,28cases right,48left,of the patients,48(25sides) males and24females with an average age of49(18-71) years were included in the study.According to the AO classification, there were16A3fractures,8C1fractures,24C2fractures and28C3fractures.8sides were treated with ilium taken andbone grafted,3sides were treated with allogeneic bone and20sides weretreated with Kirschners wire prying at the same time.The effects werecompared to analyze the volar tilt, radial inclination, radial shortening,jointdiscrepancies and wrist function preoperation and postoperation withGartland-Werley scale.Results: All the patients were followed up5~25months, an average of15months. All the fractures are healing, the average time:7weeks(4~12).According to the final review of follow-up of the wrist joint function and Xray film measuring indexes for comprehensive evaluation, all of the patientsreturn to tilt Angle, foot Angle, radial shortening, compared with preoperative articular surface steps were obviously improved.The average wrist motions ofpostoperative were as follows: palmar flexion,60°; dorsiflexion,50°; ulnardeviation,35°; radialdeviation,20°; pronation,60°; and supination,80°.The average grip strength restored to70percent of contralateral. According toGartland-Werley scale,40sides were excellent,28sides good,8sidesfair,demons-trating89percent good and excellent results. Complications:12cases with wrist pain cause by traumatic arthritis,4cases were infectionsuperficial nail way (the dressing better after),there were not nerve damage,nonunion and wrist weakness.Conclusions: The treatment of unstable fractures distal radial fractureswith external fixators combined with Kirschners wire showed goodradiological and functional results.It is one of the effective methodsb byclosed reset and the fixed support span arthrodesis to unstable distal radiusfractures, and it has definite effect, trauma smally, operation easily etc, and issuitable for clinical.