Affiliation:
1. Burdenko Main Military Clinical Hospital
2. Pirogov National Medical and Surgical Center, Moscow, Russian Federation
3. RUDN University; Moscow, Russian Federation
Abstract
Introduction. Distal radius fracture is the most frequent fracture in humans. Most authors recommend surgical treatment for intraarticular fracture. A large number of different methods of surgical treatment have been proposed. However, in the long-term treatment no significant superiority of any one method over others has been statistically revealed. Objectives. To study the results of using of Ilizarov external fixation as primary fixation (first step treatment) for the period from injury to final ORIF with a volar locked plate. Patients and methods. The study is based on the analysis of the results of surgical treatment of 81 patients with multifragmentary intraarticular distal radius fractures. These fractures are considered unstable and conservative treatment is not preferred. Patients were divided into 2 groups of 41 and 40 people. In patients of the first group (control group), at the first stage, a closed reduction was applied followed by preoperative immobilization with a classical cast bandage. Patients of the second group (study group) as the first stage of treatment performed fixation of the wrist joint with its distraction in the bridge Ilisarov external fixator. In a few days after reducing swelling all patient had ORIF with volar locked plate. To assess the function of the upper limb in the postoperative period, a DASH questionnaire was used. The results were evaluated at 3,6,12 and 18 months. Results and discussion. In 3 months after surgery revealed a significant improvement in the function of the upper limb (estimated by DASH). After 1.5 years after surgical treatment, no statistically significant difference in the result of treatment was revealed. We suppose that distraction of the wrist joint with Ilizarov external fixator accelerates reducing swelling in preoperative period of time and can improve reduction during ORIF.
Publisher
Moscow Medical - Social Institute named after Friedrich Haass
Reference24 articles.
1. Хоминец В.В., Ткаченко М.В., Сырцов В.В., Иванов В.С. Сравнительный анализ способов лечения больных с переломами дистального метаэпифиза лучевой кости. Травматология и ортопедия России. 2015. № 2 (76). С. 5-15. doi: 10.21823/2311-2905-2015-0-2-5-15, Khominets VV, Tkachenko MV, Syrcov VV, Ivanov VS. Comparative analysis of treatment technique in patients with distal radius fractures. Traumatology and Orthopedics of Russia. 2015;2 (76):5-15. (In Russ.). doi: 10.21823/2311-2905-2015-0-2-5-15
2. Makhni EC, Ewald TJ, Kelly S, Day CS. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg [Am]. 2008;33(8):1301-8. doi: 10.1016/j.jhsa.2008.04.031, Makhni EC, Ewald TJ, Kelly S, Day CS. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg [Am]. 2008;33(8):1301-8. doi: 10.1016/j.jhsa.2008.04.031
3. Price CT. Surgical management of forearm and distal radius fractures in children and adolescents. Instr Course Lect. 2008;57:509-14, Price CT. Surgical management of forearm and distal radius fractures in children and adolescents. Instr Course Lect. 2008;57:509-14
4. Rayhack JM. Symposium: Management of intraarticular fractures of the distal radius. Contemp Orthop. 1990;21:71-104., Rayhack JM. Symposium: Management of intraarticular fractures of the distal radius. Contemp Orthop. 1990;21:71-104.
5. Rayhack J, Langworthy J, Belsole R. Transulnar Percutaneous Pinning of Displaced Distal Radius Fractures: A Preliminary Report. J Ortho Trauma. 1989;3:107-114. doi: 10.1097/00005131-198906000-00004, Rayhack J, Langworthy J, Belsole R. Transulnar Percutaneous Pinning of Displaced Distal Radius Fractures: A Preliminary Report. J Ortho Trauma. 1989;3:107-114. doi: 10.1097/00005131-198906000-00004