| Background:Distal radius fractures are common upper limb fractures in orthopaedics.According to the AO classification,the incidence of C-type distal radius fractures is high and it is a challenge for surgeon to treat,the treatment options for this type is still controversial.We found no significant difference in wrist function at 6 months after external fixation brace versus plate internal fixation,but complications such as wrist stifness and poor mobility are likely to occur in the early postoperative period,so we propose that external fixation brace combined with small splint internal fixation can achieve good wrist function and reduce complications.The combination of the two phases reduces the complications of wrist stiffness after external fixator fixation and improves the rate of anatomical repositioning with a small splint alone.The protocol combines movement and immobility,shortens the duration of strong fixation,makes chances to elastic fixation,accelerates functional exercise and facilitates early functional rehabilitation of the wrist joint.1 Objective:To evaluate the effection of small splint refixation for distal radius fractures by comparing small splint refixation after external fixator removal(splint refixation group,SR)with external fixator fixation alone(external fixator group,EF)for postoperative imaging performance and wrist function.2 Method:The case report forms collected from the "clinical study of semi-annular external fixator for the treatment of C-type distal radius fracture in the elderly" and the follow-up case data were organized to establish the database of external fixation of distal radius fracture.The cases were divided into small splint refixation group and external fixation frame group.The data of imaging and wrist mobility at 1 day,4 weeks,8 weeks and 12 weeks after the external fixation frame were observed,and the data of the cases that met the observation nodes were screened and the database of this subject was established.The cases in the 2 groups were compared for postoperative fracture re-displacement,fracture healing,and functional changes of the wrist joint.3 Results:3.1 General informationA total of 55 cases of AO-C type distal radius fractures meeting the diagnostic criteria were retrieved,of which 50 cases had complete return data records.These cases were divided into 23 cases in EFgroup and 27 cases in SR group according to the presence or absence of a small splint refixation.All patients were clinically healed,the mean time is 42.44±8.41 days(38.22±1.45 in SR group which is shorter than 47.39±1.76 in EF group,P<0.05).3.2 Imaging resultsPostoperative palmar tilt,radial height and ulnar deviation angles were corrected in the 2 groups,and the differences were statistically significant when compared with the preoperative imaging results.The modified Lidstrom scoring system was used to evaluate the imaging of the two groups at 12 weeks postoperatively.The excellent rate of 95.65%in EF was higher than that of 92.59%in SR,P>0.05.Palm tilt:There was a difference between the pre-and post-treatment periods(F=45.539,p<0.05),both in the EF group and the SR group,with F values of 12.228 and 24.079 respectively,both p<0.05.Steady upward trend in postoperative palmar tilt angle in external fixation frame group and small splint refixation groupRadius height:There was a difference between the pre-and post-operation(F=25.062,p<0.05),with F-values of 9.149 in EF and 5.583 in SR,p<0.05.The height of the radius in the EF group showed a gradual upward trend.The inclination angle of the palm after the removal of the external fixator in SR group did not show a significant downward trend,and it showed a downward trend after the small splint was removed,but the difference between the two groups was not statistically significant.Ulnar deflection:There was a difference in the ulnar deviation angle between the pre-and post-treatment periods(F=23.958,P<0.05),both in the EF group and the SR group,with F-values of 9.406 and 7.227 respectively,both P<0.05.The post-operative ulnar deviation angle showed an increasing trend in the EF group,and a decreasing trend in the SR group after removal of the EF.The difference was statistically significant,indicating that there was a loss of ulnar deviation angle in the SR group after the removal of the EF group.3.3 Function ScoringVAS score:There was a difference between the pre-and post-treatment periods(F=738.295,p<0.05)in both the EF brace group and the SR group,with F values of 104.255 and 5.583 respectively,bothp<0.05.The VAS score showed a decreasing trend,indicating a gradual reduction in pain response over time after surgery.Wrist joint ROM:At 8 weeks after operation,the wrist mobility was pron ation 69.09 ± 8.15°,68.15± 8.49° in the EF frame group and the SR grou p,supination 54.61 ± 18.23°、57.89±18.39°,flexion 31.04±8.70°、35.74±12.61°;24.70±13.15°、33.04±13.05° in dorsal extension,with a statistically significant diff erence of P<0.05 for the dorsal extension statistic.The wrist mobility at 12 w eeks postoperatively was 73.43±4.26° and 73.47±8.45° prerotation;62.00±15.89°and 63.00±18.17° postrotation;49.78±17.22° and 54.22±14.27° palmar flexion;51.96±12.97° and 51.33±14.03° dorsiflexion in the EF and the SR group respe ctively,p>0.05 for comparison of wrist mobility between the 2 groups at 12 w eeks postoperatively,no statistically significant difference.G-W score:The excellent rate of the SR group at 12 weeks after surgery was 92.59%,slightly higher than that of the EF 82.61%,it was statistically significant.3.4 Efficacy evaluationThe condition of both groups impro ved to different degrees,with 14 cases cured and 9 cases improved in the EF and 16 cases cured and 11 cases improved in the SR group.4 Conclusion:The external fixation brace can be removed early and replaced by splint refixation after external fixation brace surgery in patients with AO-C type distal radius fracture,which can effectively prevent the occurrence of fracture re-displacement,improve the early postoperative function of the affected wrist,and improve the clinical efficacy. |
