DOI: https://doi.org/10.22141/1608-1706.2.20.2019.168032

Own experience of treatment of distal metaphyseal forearm fracture

I.H. Bets

Abstract


Background. Forearm distal metaphyseal (FDM) fractures remains an actual medical and social problem due to a large number (15 % of fractures in adults) and a significant number of complications following their treatment (30 % and over). The most severe complications (primarily infections and late regeneration defects) are typical for open reposition technologies and internal fixation. This is due to the unjustified expansion of indications for those clinical situations (for example, massive intra-articular traumatic destruction), in which the anatomical reposition and stabile fixation of fragments using plates and screws are very problematic. For such situations, the external fixation technique can be the method of choice. In addition, the criteria for conservative and surgical treatment are to be specified. The purpose was to objectify the criteria for the treatment techniques, improve the treatment results by analyzing the clinical results of treatment of 93 patients with FDM fractures. Materials and methods. The rational treatment tactics and designating of indications for conservative and surgical treatment can be chosen based of damage instability criteria. Internal osteosynthesis, as traumatic and dangerous in relation to complications technology, should be used only in cases when other techniques seem to be untenable (for example, in case of Barton injuries). They should be used only after a detailed clinical and radiological analysis of a specific situation, in the presence of a high degree of probability of achieving the goals of internal fixation. Results. As a result of the applied technologies of conservative treatment (35 patients), external fixation (43 patients) and internal fixation (15 patients), 72 % of good results were obtained, 22 % were satisfactory and 6 % were unsatisfactory (obtained by conservative treatment). Conclusions. Focusing on classification signs, criteria for instability, and individual characteristics of specific injuries led to a significant reduction in the indications for internal osteosynthesis, while increasing its results. This indicates the validity of this trend. External osteosynthesis, which also showed a high efficiency, seems to be a worthy and biologically justified alternative to internal fixation. The presence of a significant number of negative results of conservative treatment requires an extension of the indications for external osteosynthesis for those clinical situations in which the fixation method was found to be untenable.

Keywords


distal metaphyseal forearm fracture; external osteosynthesis; fixation method

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