On The Clinical Effect Of Different Surgical Ways For Treating The Type C Distal Radial Fractures

Objective: To analyze the differences of the clinical effects between the volar Surgical way and the dorsal Surgical way in the treatment of the type C distal radial fractures and to come up with the better choice in future surgeries.Methods: From October 2010 to December 2014,198 cases of patients who suffered the type C distal radial fractures were treated and given surgeries in Ruikang Hospital Affiliated to Guangxi University Chinese Medicine,among which 60 cases are chosen according to the criteria of this research.They can be divided into two groups,namely the group of the volar Surgical way and the group of the dorsal Surgical way,with 30 patients in the first group and another 30 in the second group.The patients were followed up after 12 months.The follow-ups include(1)damage reason,(2)the onset time,(3)treatment time in hospital,(4)the measurement of volar tilt,radial and Radial height,etc.by X-rays,(5)Gartland and Werley scoring.With these data as a basis,analysis of the two methods of treatment of the AO-type C fractures have been performed,with the statistical analysis as a major focus.Results: In the process of follow-up,68 patients were involved,while 8were out of touch due to communication failures and untimely revisit on the part of the patients,hence excluded in our research.To be specific,5 patients in the group of the volar Surgical way and 3 patients in the group of the dorsal Surgical way were excluded.The group of the volar Surgical way C1:6 cases of fracture,C2:13 cases of fracture,C3:11 cases of fracture,the group of thedorsal Surgical way C1:5 cases of fracture,C2:15 cases of fracture,C3:10cases of fracture,using Chi-square test,X2=0.281,P = 0.869 > 0.05,and with no statistical significance.Damage in different reasons,using Chi-square test,X2=0.434,P=0.933 > 0.05,and also with no statistical significance.Volar approach group hospitalization time were 14.1±4.09 days and time of operation were 101.6±22.6mins.The length of hospital stay for dorsal approach group were 14.3±4.35 days and time of operation were104.0±25.5mins.In terms of hospital stays and time of operation,the two groups are analyzed using t test(P = 0.702 > 0.05)and(P = 0.697 >0.05),and with no statistical significance.On the day of surgery X-ray parameters,the volar Surgical way(palmdip12.2±2.9°,ulnar deviation21.6±3.5°,radius height11.6±3.9mm),the dorsal Surgical way(palmdip12.2±3.1°,ulnar deviation21.1±4.1°,radius height11.1±4.1mm).When operations were completed,the X-ray parameter of the two groups was of no statistical significance(P > 0.05).After 12 months,the volar Surgical way(palmdip12.2±4.0°,ulnar deviation21.1±5.6°,radius height11.1±3.2mm),the dorsal Surgical way(palmdip10.9±6.0°,ulnar deviation19.2±7.9°,radius height7.2±4.7mm).The X-ray parameter was of statistical significance(P < 0.05).After 12 months,the volar Surgical way's wrist joint functions(GW)was 2.4±3.2 scores and the dorsal Surgical way's wrist joint functions(GW)was 5.0±5.4 scores.The wrist joint functions of the two groups were compared according to the graded Gartland and Werley evaluation,using t test,the differences are statistically significant(P = 0.034< 0.05).After 12 months,the volar Surgical way's wrist joint activity(palm down 51.40±4.25°,back stretch51.07±2.60°,radial deviation21.20±1.73°,ulnar deviation30.23±2.03°),thedorsal Surgical way's wrist joint activity(palm down 49.13±6.26°,back stretch49.67±4.81°,radial deviation21.73±1.66°,ulnardeviation31.07±1.87°).The wrist joint functions of the two groups were compared according to the wrist joint activity,using t test,two groups was of no statistical significance(P > 0.05).All these comparisons and contrasts boil down to the conclusion that the volar group is superior to the dorsal approach,therefore,the former method should be given priority with other conditions being equal.Conclusion: After 6 months,the efficacy of the volar Surgical way in treatment of type C distal radius fractures is better than the dorsal Surgical way,which manifests itself in the less loss of the volar tilt and radial and Radial height.After 12 months,the patients with the former treatment have a slightly better recovery.Therefore,the volar surgical approach should be preferred with other conditions being equal.