| Objective: Distal unstable A3 fracture of radius has the risk of reduction loss after fracture reduction,and improper treatment leads to poor wrist function.Therefore,splint combined with percutaneous Kirschner wire fixation for the treatment of unstable distal radius A3 fracture is proposed.This study is a part of this series of studies,observing the rehabilitation of wrist joint after treatment with this method.Methods: 60 patients with unstable distal radius A3 fracture treated in Fuzhou Second Hospital from January 2021 to December 2021 were randomly divided into experimental group with 30 patients in each group by simple randomization.The experimental group was fixed with Kirschner wire of ulnar radial joint combined with small splint after manual reduction,while the control group was fixed with small splint combined with cushion after manual reduction.On the first day after fixation,the patient was instructed to exercise hand function;The Kirschner wire was removed in the experimental group at the 4th week,and the splints were removed in the two groups at the 6th week.After the splint was removed,the patients were instructed to take active and passive functional exercises for 6 weeks:(1)take the initiative in wrist flexion and extension and rotation;Flexing,stretching and rotating alternately;Maintain each for 5-10 s,10 times in each set,and continue for 3 set.Three set per day.(2)With the help of family members,bend and stretch wrist joints in small amplitude and slowly,and each state lasts for 5-10 s.A complete cycle of flexion and extension is 1,10 times in each set,3 set per day.During the treatment period,the patients’ pain was recorded on the day of treatment,the 1st week,the 6th week and the 12 th week.At the 12 th week,wrist joint mobility,grip strength and Gartland-Werley scale were measured and recorded.Results:1.The number of patients with unstable distal radius A3 fracture is mostly elderly women in epidemiology.There is no significant difference in age,sex,injured position and dominant hand side between the two groups(P > 0.05),and the two groups are comparable.2.There was no significant difference in VAS scores between the two groups on the day of treatment(P > 0.05),which was comparable.One week after operation,the VAS score of patients in the experimental group was higher than that in the control group,and the difference was statistically significant(P < 0.05).6th week after operation,there was no significant difference in VAS between the two groups(P > 0.05).At the 12 th week after operation,there was no significant difference in VAS scores between the two groups(P > 0.05).3.The average grip strength of the control group is 20.21±2.73 N,and that of the experimental group is 22.10±3.47 N.The grip strength of the experimental group is slightly higher than that of the control group,with statistical significance(P < 0.05).4.The 12 th week after operation,there was no significant difference in the flexion and extension of the palm between the two groups(P > 0.05).There was significant difference in forearm pronation angle between the two groups,and the experimental group was better than the control group(P < 0.05).There was significant difference in forearm supination angle between the two groups,and the experimental group was better than the control group(P < 0.05).5.The 12 th week after operation,the results of Gartland-Werley score in the two groups were excellent in 5 cases,good in 19 cases,fair in 5 cases and poor in 1 case in the control group,and excellent in 9 cases,good in 17 cases,fair in 4 cases and poor in 0 cases in the experimental group.The excellent and good rate of the experimental group was 86.7% higher than that of the control group(80%).Conclusion: Compared with splinting alone,splinting combined with Kirschner wire fixation of the lower radioulnar joint is beneficial to the recovery of patients’ forearm rotation function and grip strength,and can obtain better wrist function.This method is worthy of clinical application. |
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