| Objective1.To compare the distribution differences between the younger and elderly people of Colles fracture based on Frykman classification and Mayo classification.2.To compare the evaluation of Frykman classification and Mayo classification between digital radiography(DR)and multi-slice spiral computed tomography(MSCT)in Colles fracture.3.To evaluate the prognosis of Colles fracture in the elderly people treated by different strategies based on Frykman classification and Mayo classification.Methods1.620 cases of Colles fracture confirmed by digital radiography initially were retrospectively analyzed.According to the world health organization(WHO)standard of age,these patients were divided into two groups:younger group(<60 years old)298 cases and elderly group(?60 years old)322 cases.All x-ray films of the patients were observed and analyzed by two attending physicians,Frykman classification including the extra-articular fracture and the intra-articular fracture and Mayo classification for intra-articular fracture were identified respectively.The distribution and incidence of Colles fracture for Frykman classification and Mayo classification in younger and elderly patients were listed by dual histogram and compared by Chi-square test.2.108 cases of Colles fracture confirmed by both digital radiography(DR)and multi-slice spiral computed tomography(MSCT)were retrospectively analyzed.On the basis of detection results for digital radiography(DR)observed and analyzed by two attending physicians,the consistency and difference of detection results for multi-slice spiral computed tomography(MSCT)on Frykman classification and Mayo classification were evaluated.And then outcomes were compared by McNemar Chi-square test and Kappa test.3.59 cases of Colles fracture in the elderly people who had complete x-ray films and clinical follow up datas within a year or so were retrospectively analyzed.At the last follow up,the relationship between two treatment strategies including closed reduction and plaster immobilization(CRPI),open reduction and internal fixation(ORIF)and prognosis indexes,including radial volar tilt(RVT),radial inclination(RI),radial shortening(RS)and Gartland-Werley wrist joint scoring,of Colles fracture for Frykman classification and Mayo classification were evaluated respectively.Acceptable rates of Gartland-Werley wrist joint scoring were compared by Chi-square test and fisher exact test.Measurement values of each prognosis index were compared by Kolmogorov-Smimov nomal distribution test,independent sample t-test and Mann-Whitney U test.Results:1.The overall distributions of Colles fracture were statistically significantly different between younger group and elderly group based on Frykman classification(P<0.05).Type ?,?,?,? were more common in younger group and type ?,?,?,?were more common in elderly group.The extra-articular fracture and the intra-articular fracture respectively accounted for 43.62%,56.38%in younger group and 28.57%,71.43%in elderly group,which showed statistically significant differences between the two groups(P<0.05).Colles fracture without and with ulnar styloid fracture respectively accounted for 19.68%,59.06%in younger group and 38.20%,61.80%,which showed no statistically significant differences between the two groups(P>0.05).The single radiocarpal intra-articular fracture(type ?,?)respectively accounted for 35.91%in younger group and 46.89%in elderly group,which showed statistically significant differences between the two groups(P<0.05).The overall distributions of Colles fracture were no statistically significantly different between younger group and elderly group based on Mayo classification(P>0.05).The single radioulnar intra-articular fracture(type ?)respectively accounted for 20.24%in younger group and 23.48%in elderly group,which showed no statistically significant differences between the two groups(P>0.05).The single radioscaphoid intra-articular fracture(type ?)respectively accounted for 6.97%in younger group and 12.30%in elderly group,which showed no statistically significant differences between the two groups(P>0.05).The single radiolunate intra-articular fracture(type ?)respectively accounted for 48.21%in younger group and 50.43%in elderly group,which showed no statistically significant differences between the two groups(P>0.05).The complex intra-articular fracture(type?)respectively accounted for 21.43%in younger group and 13.04%in elderly group,which showed statistically significant differences between the two groups(P<0.05).2.The consistency of detection on Frykman classification in Colles fracture between DR and MSCT was general,and the kappa value was 0.365.The detection rate on Frykman classification from type ? to type ? by DR was respectively 1.85%,7.41%,23.15%,35.19%,5.56%,11.11%,7.41%,8.33%,and the detection rate by MSCT correspondingly was respectively 1.85%,5.56%,7.41%,6.48%,1.85%,4.63%,21.30%,50.93%,which showed statistically significant differences of detection on type?,?,?,?,? by two imaging methods(P<0.05).The consistency of detection on Mayo classification in Colles fracture between DR and MSCT was general,and the kappa value was 0.317.The detection rate on Mayo classification from type I to type IV by DR was respectively 18.75%,10.42%,47.92%,22.92%,and the detection rate by MSCT correspondingly was respectively 9.38%,5.21%,13.54%,71.88%,which showed statistically significant differences of detection on type ?,?,? by two imaging methods(P<0.05).3.The Gartland-Werley wrist joint scorning rates of acceptable outcomes for the extra-articular fracture and the intra-articular fracture were respectively 83.30%and 53.20%,which showed no statistically significant differences(P>0.05).The Gartland-Werley wrist joint scorning rates of acceptable outcomes for the extra-articular fracture and the intra-articular fracture treated by CRPI were respectively 77.80%and 70.00%,which showed statistically significant differences(P<0.05).The Gartland-Werley wrist joint scorning rates of acceptable outcomes for the extra-articular fracture and the intra-articular fracture treated by ORIF were respectively 100.00%and 94.10%,which showed no statistically significant differences(P>0.05).Based on Frykman classification,it was found that the difference for prognosis indexes RVT,RI,RS and Gartland-Werley wrist joint scorning of the extra-articular fracture between CRPI and ORIF were statistical significance(P<0.05).It was found that the difference for prognosis indexes RVT,RI,RS and Gartland-Werley wrist joint scorning of the single radiocarpal intra-articular fracture(type ?,?)between CRPI and ORIF were statistical significance(P<0.05).It was found that the difference for prognosis indexes RVT,RI,RS and Gartland-Werley wrist joint scorning of the single distal radioulnar intra-articular fracture(type ?,?)between CRPI and ORIF were not statistical significance(P>0.05).It was found that the difference for prognosis indexes RVT,RI,RS and Gartland-Werley wrist joint scorning of the radiocarpal and the radioulnar intra-articular fracture(type ?,?)between CRPI and ORIF were statistical significance(P<0.05).Based on Mayo classification,it was found that the difference for prognosis indexes RVT and Gartland-Werley wrist joint scorning of the single radioulnar intra-articul fracture(type I)between CRPI and ORIF were statistical significance(P<0.05),while the difference for prognosis indexes RI,RS of this type between CRPI and ORIF were no statistical significance(P>0.05).It was found that the difference for prognosis indexes RVT of the single radioscaphoid intra-articular fracture(type II)between CRPI and ORIF were statistical significance(P<0.05),while the difference for prognosis indexes RI,RS and Gartland-Werley wrist joint scorning of this type between CRPI and ORIF were no statistical significance(P>0.05).It was found that the difference for prognosis indexes RVT,RI,RS and Gartland-Werley wrist joint scorning of the single radiolunate intra-articular fracture(type III)between CRPI and ORIF were statistical significance(P<0.05).It was found that the difference for prognosis indexes RVT,RI,RS and Gartland-Werley wrist joint scorning of the complex intra-articular fracture(type IV)between CRPI and ORIF were statistical significance(P<0.05).There were statistically significant differences for the prognosis index RVT of any type intra-articular fracture between CRPI and ORIF(P<0.05).Conclusion:1.The overall distributions of Colies fracture were statistically significantly different between younger people and elderly people based on Frykman classification.The extra-articular fracture was more common in younger people,while the intra-articular fracture especially the single radiocarpal intra-articular fracture was more common in elderly people.The overall distributions of Colles fracture were no statistically significantly different between younger people and elderly people based on Mayo classification.However the complex intra-articular fracture was more common in younger people.2.The consistency of detection on Frykman classification and Mayo classification in Colles fracture between DR and MSCT was both general.MSCT was more comprehensive and accurate for evaluation in intra-articular fracture.3.Based on Frykman classification,the Gartland-Werley wrist joint scorning rates of acceptable outcomes for the extra-articular fracture were much better than intra-articular fracture.The prognosis of the extra-articular fracture,the radiocarpal and radioulnar intra-articular fracture treated by ORIF was obviously superior to CRPI.Based on Mayo classification,the prognosis of the single radiolunate intra-articular fracture and the complex intra-articular fracture treated by ORIF was obviously superior to CRPI.For any type of intra-articular fracture,the recovery of RVT treated by ORIF was obviously superior to CRPI. |
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