Analysis On Long-term Curative Effects Of Distal Radius Fracture C Type Treated By ORIF And EF

Objective: The fracture of the distal radius is one of the most common injuries among fractures of upper limb,which is defined as the fractures happened between the articular surface and the distal radius 2-3cm.However,there are a lot of controversies in the treatment of distal radius fracture due to its limiting factors such as the mechanism of injury,age,fracture stability and subjective evaluation.Distal radius fracture has various types of treatments,among which the most common ones are closed reduction plus plaster fixation,Percutaneous Pinning fixation,external fixation and open reduction plus internal fixation.A large body of researches suggested that satisfactory therapeutic effect can be achieved in most stable and extra-articular distal radial fractures with closed reduction and plaster or splint fixation.Nevertheless,for the unstable andintro-articular distal radius fractures,the operative therapy is prefered.Additionally,there is no significant difference in the long-term subjective function between the conservative and surgical treatment of distal radius fracture for the elderly over 65 years old In this study,the therapeutic effects of open reduction and internal fixation on the distal radius frature(Type C)in the elder over 65 years were compared with that using the external fixation.Research Method: Aretrospective study has been performed.99 medical charts of the patients suffered to DRF type C from January 2010 to March 2015 were reviewed.31 cases were enrolled in this study.Inclusion Criteria: 1.Under 65 years old;2.fresh,non-pathological and close fracture;3.C type fractures of the distal radius diagnosed by X-ray imaging 4.With operative indications: height loss in radius > 3mm,joint surface subsidence > 2mm,dorsal angulation > 10°;5.Surgical treatment performed within one week after injury.Exclusion Criteria: 1.Stable fracture of the distal radius over 65 years old;2.Open fracture;3.Associated neurovascular injures;4.Patients with systemic disease who cannot tolerate surgeryOpen reduction and volar plate fixation group: 16 cases in total.Male: 9 cases;Female: 7 cases;Left side: 10 cases;Right side: 6 cases;Age range: from 30-62;Average age: 47.63±9.05;AO classification: C1 5 cases;C2 6 cases;C3 5 cases;Injury mechanism: 1 case of car accident;15 cases of fall injury;Concurrent injury: 1case of combined scaphoid fracture;2 cases of Combined ulnar styloid fracture;1case of combined ulnar styloid and 5th metacarpal fracture.External fixation group: 15 cases in total.Male: 9 cases;Female:6 cases;Left side:9cases;Right side:6 cases;Age range: from 30-62;Average age: 49.13±10.82;AO classification: C1 6 cases;C2 6 cases;C3 3 cases;Injury mechanism: 1 case of car accident;2 cases of high fall injury;12 cases of fall injury;Concurrent injury: 1 case of combined distal ulnar fracture and olecranon fracture;2 cases of combined distal ulnar fractures;3 cases of ulnar styloid fracture.A series of postoperative parameter(postoperative radial styloid process level,radial incline,radial inclination,wrist activity and Gartland-Werley score)were gathered and compared between two groups.In the last follow-up X-ray showed fracture healing as the standardResults: All the patients were followed up.Fracture healing was judged by the last follow-up X-ray images..The average follow-up time in the group of open reduction volar plate fixation-was 24 months;The average follow-up time in the group of external fixation was 46 months.Among the data in the last follow-up(),only the radial inclination is normally distributed data.T test was adopted to the radial inclination analysis for the normally distributed data.The rest data(radial styloid process level,wrist activity and Gartland Werley score)is eligible to non-parametric test for their non-normally distribution.All the data was analyzed by the SPSS 19.0.There was no statistical difference in the radial styloid process level,radial incline,radial inclination,wrist activity and so on between two groups(P > 0.05).There was statistical significance in the start time of early functional exercise(P < 0.05).One case of median nerve injury,one case of tendon adhesion,one case of traumatic arthritis and one case of Complex Regional Pain Syndrome(CRPS)were observed in the group of open reduction and volar plate fixation;one case of joint stiffness was observed in the group of external fixation.Conclusion:The stable fixation of open reduction volar plate fixation and,along with early functional exercise,is significant for the postoperative functional recovery of distal radius fractures,but there was no difference between the two groups in the long-term.Nevertheless,considering the soft tissue injury and the excellent rate of Gartland-Werley score,external fixation is more advantageous for the soft tissue protection.