Treatment of Unstable Distal Ulna Fractures Associated With Distal Radius Fractures in Patients 65 Years and Older
Treatment of Unstable Distal Ulna Fractures Associated With Distal Radius Fractures in Patients 65 Years and Older
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DOI：
10.1016/j.jhsa.2012.07.031
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发表时间：
2012-12-01
影响因子：
1.9
通讯作者：
Park, Eugene
中科院分区：
文献类型：
--
作者：
Cha, Soo-Min;Shin, Hyun-Dae;Park, Eugene
目的 前瞻性比较 65 岁及以上患者尺骨远端骨折伴桡骨远端骨折的 2 种治疗方法的临床和影像学结果。 方法 2008 年 2 月至 2010 年 3 月，前 29 根尺骨接受手术治疗（组 1），随后的 32 根尺骨接受非手术治疗（组 2）。平均最终随访期为 34 个月（范围：24-56 个月）。两组的所有半径均在内部固定。使用术后疼痛视觉模拟量表比较各组之间的临床结果；手臂、肩部和手部残疾评分；主动运动范围；握力；以及 Gartland 和 Werley 的修正系统。评估放射学结果，包括尺骨方差。根据 Knirk 和 Jupiter 系统评估桡腕关节或远端桡尺关节 (DRUJ) 的关节情况。结果 各组之间的任何临床结果均无显着差异。包括尺骨变异、桡骨远端和愈合率在内的放射学结果没有观察到显着差异。在最后一次随访时，两组患者均没有出现桡腕关节或 DRUJ 症状性关节炎改变。在第 2 组中，1 名患者前后位观察有畸形愈合（成角，14 度），没有 DRUJ 关节的证据，功能结果良好。 结论 在该人群中，当尺骨远端骨折与桡骨远端骨折合并发生时，可以通过非手术成功治疗。美国手外科学会版权所有 (C) 2012。版权所有。
Purpose To prospectively compare the clinical and radiological outcomes of 2 treatment methods for unstable distal ulna fractures associated with distal radius fractures in patients 65 years of age and older.Methods From February 2008 to March 2010, the first 29 ulnas were treated surgically (group 1) and the next 32 ulnas were treated nonoperatively (group 2). The mean final follow-up period was 34 months (range, 24-56 mo). All radiuses were fixed internally, in both groups. Clinical outcomes were compared between groups using a visual analog scale for postoperative pain; Disabilities of the Arm, Shoulder, and Hand scores; active range of motion; grip strength; and the modified system of Gartland and Werley. Radiological outcomes, including ulnar variance, were evaluated. Arthrosis was evaluated at the radiocarpal joint or distal radioulnar joint (DRUJ) according to the system of Knirk and Jupiter.Results There were no significant differences between the groups in any of the clinical outcomes. No significant differences were observed for radiological outcomes including ulnar variance, distal radius, and union rate. There were no patients in either group with symptomatic arthritic changes in the radiocarpal joint or DRUJ at the final follow-up. In group 2, 1 patient had malunion (angulated, 14 degrees) on the anteroposterior view without evidence of arthrosis in the DRUJ, and functional outcomes were good.Conclusions In this population distal ulna fractures can be successfully managed nonoperatively when they occur in combination with distal radius fractures. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.