Clinical And Preliminary Biomechanics Research To The Treatment Of C-Type Distal Radois Fractures By Bone-Setting Manipulation Coordinated With The Semicircular External Fixing Frames

The distal radius fracture refers to the distance of the bottom radius articular surface within3cm,and it mostly belongs to closed fracture. distal radius fracture is one of most common orthopedic emergencies that it about15%of adult fractures. The bottom of radius is range of anatomical vulnerabilities that easy to fracture when external force once,the most fractures can cumulated wrist at the same time and caused disorder of palmar tilt and ulnar inclination.the fractures commonly use closed manipulative reduction and splint or plaster fixation,open reduction and plate internal fixation operation. But to C-type distal radius fracture,these methods poor efficacy and affected the function of the limb rehabilitation on later.Because of the cost and indications, a large number of C-type distal radius fracture wouldn’t have been as hard to treat by open reduction and internal fixation operation. Not only expensive treatment cost, but also it give rise to more complications, second operation and operative risk. Although splint or plaster fixation has advantages of simple and cheap, the fractures neglected unstable factors and it could causes complications, such as malunion,carpal arthritis,grip strength descend, Sudeck osteanabrosis and arthrosis etc. Nowadays,the fractures treated by alternative unilateral external fixator while it failed to exert obvious advantage due to the coarse screw needle and fixed limited. Similar studies were reported at home and abroad,clinical curative effect is not satisfactory because of a variety of the structure of the external fixator and fixation means.Our hospital has rich clinical experience and thick accumulation on common fractures treatment with external fixation of TCM. By wearing thin needle and fixed half ring external fixator,it can cure type C of the distal radius fractures quickly and effectively.This method is convenient to be used in carried out in grass-roots and reduce the medical cost, it also cater to the tide of medical reform in our country. For that reason,It extremely urgent to establish a kind of the standardized diagnosis and treatment for C-type distal radius fracture. According to clinical exploratory study and clinical observation to improve diagnosis and treatment schemes and improve the cure rate continuously. Thus, it can let down external fixator diagnosis and treatment of C-type distal radius fractures more standardized, efficiency and easy.1Clinical research to the treatment of C-type distal radius fracture by bone-setting by manipulation coordinated with the semicircular external fixing frames1.1PurposeBased on the previous clinical experience and the theory of wrist transfixation anatomy studies, Treated with C-type distal radius fracture bone-setting by manipulation coordinated with the semicircular external fixing frames. Verify the feasibility and security of treatment through the exploratory clinical research and observed its effect.Improved reduction, percutaneous pinning and fixation of C-type distal radius fracture, lay the foundation for standardized external fixing frame diagnosis and treatment of distal radius fracture. Finally, the method is essential to reduce complications and improve the cure rate.1.2Object and Method48cases with complete data of type C distal radial fracture from September2009to December2012in our hospital were selected. The patients treated with bone-setting manipulation coordinated with the semicircular external fixing frames,and to undertake clinical observation.Data collected and analyzed through clinical score of symptoms and signs, the assessment of anatomy and wrist score sheets, and evaluate its clinical efficacy at the same time.1.3Results48patients of the group were obtained for follow-up visits meaning hundred-percent of those treated had follow up visits. The group patients were followed for18months to30months, and the average follow-up period was6months. External fixing frames were dismantled in4-6weeks after surgery, with fractures reaching the clinical healing standard. Surgery healing time was8-14weeks, and the average wads9weeks. Without complications such as traumatic osteoarthritis, anchylosis and pinhole infection occurred after surgery. Palmar tilt was9°～14°and ulnar inclination was18°～25°after external fixing frames removed,l case still has3mm of radial axial shortening and2cases has1.5-2.5mm of the collapse of articular facet simultaneously. In terms of wrist activity, ipsilateral and contralateral had no significant difference after concrescence.But to the power of gripping, the ipsilateral to contralateral above85%.According to Gartland-Werley wrist score sheets and Mayo wrist score sheets used in assessing clinical curative effect, the good to excellent rate reached91.2%and93.75%respectively,both the overall response rates reached100%.1.4ConclusionThe clinical effects of bone-setting manipulation coordinated with the semicircular external fixing frames is confirmed for C-type distal radius fractures,the healing time has obviously been reduced,fewer complications have occurred joint function recovered satisfactorily,therefore it has a good value for application and deserves popularization,medical reference and to be used clinically.2Preliminary biomechanics research to the treatment of distal radius fracture with external fixing frame2.1PurposeUnder the condition of simulated loading wrist,to study the fixation stability of the distal radius fracture fixed with half-ring type external frame and single-arm external frame compression load state comparatively. Meanwhile,explore and analysis the mechanics mechanism of the fractures under stress conditions preliminarily.2.2Object and MethodSelecting natural thawed specimens of adult body forearm (including elbow),and the gross Observation without limbs trauma and deformity. The experimental group fixed with half-ring type external frame and control group fixed with single-arm external frame.Contrast the stability of the two methods of fixation through compression loading.2.3Results After the specimen immobilized,through the compression loading of begin with20N to100N by universal testing machines persistently.Imaging showed the two groups had no obvious fracture displacement and radial axial shortening after compression,And the model appearance without abnormal change.The average slope of experimental group is103.30,compression stiffness is103300N/m,and the average displacement is0.77mm being compression loaded to100N.Moreover,the average slope of control group is56.11,compression stiffness is56110N/m,and the average displacement is1.53mm being compression loaded to100N.2.4ConclusionThe fixation stability of the distal radius fracture fixed with half-ring type external frame was superior to single-arm external frame under compression load state.This shows that the curative effect of half ring external frame is more reliable for the treatment of distal radius fractures.