Efficacy Of Small Splints Combined With External Fixation In Plaster After Closed Reduction Of Distal Radius Type C1 Fractures In The Elderly

Objective:We observe the short-term clinical efficacy of small splints combined with plaster fixation in the treatment of C1-type geriatric distal radius fractures to verify the effectiveness of this therapy,and conduct a preliminary discussion on its principle of action,summarize its advantages and disadvantages,provide data reference for the selection of external fixation after closed reduction of C1-type geriatric distal radius fractures.Methods:In this study spanning December 2020 to December 2021,Elderly patients with distal radius fractures were enrolled from the Closed reduction clinic of Tianjin Hospital in Tianjin who met the diagnostic criteria,and had complete data were assigned to observation group and control group,each with 30 patients,whether their fixation method was fixed with a small splint combined with a plaster after closed reduction.We summarized the clinical data of the imaging data,hand swelling scores and wrist joints function of all patients,while we observed the imaging data,changes in signs,wrist function levels and Complications occurred during fixation of the two groups.The hand swelling scores and the imaging data(the radial height,the palmar tilt,the ulnar declination angle)were collected preoperatively,immediately after surgery,4 weeks after surgery,and 12 weeks after surgery;And the patient-rated wrist evaluation(PRWE)of all patients at 12 weeks after surgery was collected and recorded by us,At last,SPSS26.0 software was performed to analyze the data of both groups to study the fixation effect of small splints combined with plaster fixation in the treatment of C1-type distal radius fractures in the elderly.Results:(1)A total of 60 patients were included in this study,30 cases in the observation group,7males and 23 females;30 cases in the control group,12 males and 18 females.There were no statistical differences in baseline information such as gender,age,and distribution of affected limbs(P>0.05).and the two groups were comparable.(2)Comparison of imaging parameters:There was no significant difference in imaging data immediately after reduction between the two groups(P>0.05).radial height:There was an interaction between time point factor and group between the two groups(P<0.001);the main effect of time factor on radial stem height,the results showed a statistical significance(P<0.001);the analysis of the between-subjects effect test for radial stem height showed a statistical difference between the two groups(P<0.001).The radial stem height in the observation group was significantly better than that in the control group at 4 weeks and 12 weeks after repositioning after the two-two comparison(P<0.001;P<0.001).In the observation group:radial stem height decreased at 4 weeks and 12 weeks after resetting compared with the immediate post-resetting period(P<0.05;P<0.001).The height of the radial decreased at 12 weeks after repositioning compared with 4 weeks after repositioning(P<0.001).Control group:radial height decreased at 4 weeks and 12 weeks after resetting compared with immediately after resetting(P<0.001;P<0.001).Radial stem height decreased at 12 weeks after resetting compared with 4 weeks after resetting(P<0.001).Palmar inclination angle:there was an interaction between time point factor and group between the two groups(P<0.05);analysis of the main effect of time factor on Palmar inclination angle showed statistical significance(P<0.001);analysis of the between-subjects effect test for palmar inclination showed a statistical difference between the two groups(P<0.05).The palmar inclination angle of the observation group was better than that of the control group at 4 weeks after resetting(P<0.05).There was no statistical difference between the palmar tilt angle of the observation group and the control group at 12 weeks after resetting(P>0.05).In the observation group,there was no statistical difference between the palmar tilt angle at 4 weeks after resetting and that immediately after resetting(P>0.05).There was no statistical difference between the palmar inclination angle at 4 weeks after resetting and 12weeks after resetting(P>0.05).The palmar inclination angle at 12 weeks after resetting was decreased compared to the palmar inclination angle immediately after resetting(P<0.05).In the control group,the palmar inclination angle decreased at 4 weeks and 12 weeks after resetting compared with that immediately after resetting,and the difference was statistically significant(P<0.001;P<0.001).There was no statistically significant difference between the palmar inclination angle at 4 weeks after resetting and 12 weeks after resetting(P>0.05).Ulnar deviation angle:there was no interaction between time point factor and grouping between the two groups(P>0.05);analysis of the main effect of time factor on ulnar deviation angle showed statistically significant results(P<0.001);analysis of the between-subjects effect test for ulnar deviation angle showed no statistical difference between the two groups(P>0.05).Observation group:compared with the ulnar deviation angle immediately after reset,the ulnar deviation angle was reduced at 4 weeks after reset and 12 weeks after reset compared with before,and it was statistically significant(P<0.05;P<0.001);there was no statistical difference between the ulnar deviation angle at 4 weeks after reset and 12 weeks after reset(P>0.05).In the control group,compared with the ulnar deviation angle immediately after resetting,the ulnar deviation angle was reduced at 4 weeks after resetting and 12 weeks after resetting,and was statistically significant(P<0.05;P<0.001);there was no statistical difference between the ulnar deviation angle at 4 weeks after resetting and 12 weeks after resetting(P>0.05).(3)Hand swelling scores:There was no statistical difference in hand swelling score immediately after reduction between the two groups(P>0.05).There was an interaction between time factor and grouping between the two groups(P<0.05);analysis of the main effect of time factor on swelling scores showed statistical significance(P<0.001);and analysis of the between-subjects effect test for hand swelling scores showed statistical differences between the two groups(P<0.05).After a two-by-two comparison of the two groups,the results showed that the swelling score was higher in the observation group than in the control group at 4 weeks after repositioning(P<0.001),and there was no statistical difference between the observation group and the control group at 12 weeks after repositioning(P>0.05).A two-by-two comparison within the observation group at different time points showed that compared with the hand swelling scores immediately after resetting,the hand swelling scores at 4 weeks after resetting and 12 weeks after resetting were reduced compared with the previous ones and were statistically significant(P<0.05;P<0.001);compared with the hand swelling scores at 4 weeks after resetting,the hand swelling scores at 12 weeks after resetting were reduced compared with the previous ones(P<0.05).A two-by-two comparison within the control group showed a statistically significant decrease in hand swelling scores at 4 weeks after resetting and 12 weeks after resetting compared with those immediately after resetting(P<0.001;P<0.001);there was no statistical difference between hand swelling scores at 12 weeks after resetting and 4 weeks after resetting(P>0.05).(4)PRWE:comparison between groups:wrist function scores in the small splint combined with plaster fixation group at 12 weeks after surgery were better than those in the plaster fixation group,the level of wrist function in the plaster fixation group was better than that in the small splint combined with plaster fixation group,but there was no statistical difference between them(p>0.05).(5)Evaluation of the efficacy:the overall significant rate(96.7%)of the small splint combined with plaster fixation group was significantly better than that of the plaster fixation group(70%),with statistical differences(p<0.05).(6)Complications during fixation:In this study,neither carpal tunnel syndrome nor forearm septal zone syndrome occurred in the two groups.In the group of small splint combined with plaster fixation,1 cases of malunion and 2 cases of tension blister;There were 9 cases of malunion and 0 cases of tension blister in plaster fixation group.The incidence of complications was 30%in the control group and 10%in the observation group,and the difference between the two groups was not statistically significant(x~2=3.750,P>0.05).Conclusion:(1)Small splint combined with plaster fixation has a better maintenance effect than plaster fixation alone in the treatment of C1 distal radius fractures in the elderly,which can effectively reduce the risk of malunion of distal radius fractures in the elderly.(2)The combination of small splints with external fixation in plaster,which is a characteristic of TCM orthopaedic treatment,effectively combines small splints with external fixation in plaster with Western medicine,and is also an important embodiment of the idea of combining motion and static in TCM orthopaedics,which improves the effect of non-operative treatment of C1 type distal radius fracture in the Elderly.