The Issue of Treatment of Common Distal Radius Fractures

P.I. Bilinsky, O.V. Drobotun, D.I. Palamar, O.A. Tikhonov, D.V. Kravchenia

Abstract


Background. Among all kinds of the upper limb fractures the most common are distal radial fractures (DRF). Their proportion is up to 40–45 % of all skeletal fractures. The use of modern means of conservative and operative fixation of fragments in DRF does not always ensure a good outcome. In order to prove such methods of treatment DRF it should be fully explored through effective methodological approaches. Objective: to analyze current trends of conservative and surgical treatments DRF and identify factors influencing their results. Materials and methods. We have conducted a systematic analysis (SA) of the main factors of conservative and surgical treatment of DRF. Moreover, we have studied literature, methods of conservative treatment, the use of LCP-plates, external fixation devices at DRF. We have also identified the causes of possible complications and the factors that influence the outcomes of these injuries. Available radiographs and medical records, medical history of 55 patients with complications and negative results of use of modern means of osteosynthesis were studied. We have analyzed the means to stabilize the fracture as well as the possibility of closed reposition of the fragments in which there are biomechanical conditions. The interaction of bandages with a fragment was studied. It mostly defines the processes occurring on the contact line of chips and provides the ultimate outcome of the fracture. Results. Anamneses, clinical picture, bi-plane X-ray (straight and lateral) are crucial for the DRF diagnosis. Proper assessment of the nature of fracture and displacement of the distal fragment identifies the further treatment strategy. It should be remembered that articular facet ulna head is 0.5–1 cm proximal to articular surface of the radial bone, which is inclined to the palm side at an angle of 10°. Its horizontal position is allowed. The normal angle between the articular surface of the radial bone and perpendicular to the axis of diaphysis on straight radiographs is 30°. The displacement of ulna head in the distal direction and change of radioulnar angle (without reposition) will lead to restricting drainage elbow and wrist — arm rotational movements. Incorrect interpretation of radiographs defines further false tactic, increases the number of complications and unsatisfactory results. We have observed seven patients whose X-rays have been assessed incorrectly and, consequently, it has caused inefficient method of treatment that affected the outcome. Conclusions. Thus, the use of SA main factors of conservative and surgical treatment of DRF makes it possible to determine the influence of drugs on fixation of bone fragments. Receiving a good final result can be thoroughly analyzed in the nature of the fracture line, selecting the most optimal biomechanically reasonable methods of treatment, methodically correct in its performance.


Keywords


common fractures radial bone; conservative treatment, surgical treatment

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DOI: https://doi.org/10.22141/1608-1706.6.17.2016.88613

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