Criteria for choosing the technologies for treating injuries of the distal metaephyphysis of the forearm bones

I.G. Betz


Background. Injuries of the distal metaepiphysis of the forearm bones are 15 % of bone fractures in adults. About 53.3 % require reposition of bone fragments; half of them (26.6 %) are severe unstable fractures type B and C (according to AO classification), whose treatment is mostly associated with surgical interventions. The remaining 46.7 % of injuries of the distal metaepiphysis of the forearm bones are fractures without dislocation of fragments or those in which the value of dislocation does not exceed the permissible parameters (according to the quality criteria of repositioning). These injuries are treated outpatiently using immobilization method. However, the practice of providing trauma care at the outpatient stage indicates that attempts to reposition fragments in this localization are made in the majority of patients without taking into account the classification features of fractures, and only unsuccessful attempts to fix fragments (sometimes repeated) or secondary dislocation are the reason for sending the patient to a hospital (unfortunately, within 2–4 weeks or more). The purpose of the study was to clarify and objectify the criteria for choosing technologies for treating injuries of distal metaepiphysis of the forearm bones on the basis of clinical research. Materials and methods. Treatment outcomes were analyzed in 100 patients sent to the hospital after unsuccessful attempts of outpatient treatment. Thirty eight patients underwent repeated closed reposition and conservative treatment in hospital, 45 persons — extrafocal distraction osteosynthesis. Results. Analysis of treatment outcomes made it possible to draw conclusions that in the injuries of the distal metaepiphysis of the forearm bones, it is advisable to perform repeated reposition with further conservative treatment in the hospital, which provides positive results in 84 % of cases given that the risk of recurrent dislocation does not exceed 3 points. When the risk of recurrent dislocation is 4–5 points, either an open reposition of fragments and osteosynthesis, or an external osteosynthesis are indicated. With fractures type A, B and C, where the amount of fragments allowed fixing them with plates and screws of 3.5 mm (and in the absence of impression distraction), it is possible to perform bone osteosynthesis (anatomical reposition, reliable fixation without additional immobilization, early function). Only such a result of internal fixation can justify the traumatism and high risk of complications of this technology. Conclusions. External osteosynthesis differs in terms of universality and compliance with biological principles, while it gives stably positive results in the treatment of fractures of the distal metaepiphysis of the forearm bones, in the absence of complications.


distal metaepiphysisof the forearm bones; fragment reposition


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