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Treatment and clinical results of distal radial fractures nonunion or delayed union

摘要


Background: Nonunion of the distal radius fracture is extremely rare due to metaphyseal location, cancellous bone content and usually few soft tissue disruption. Surgical management of the distal radius nonunion is usually indicated but represents a clinical challenge. Purpose: We reported our results of surgical treatment of distal radius fracture nonunion in recently decade. Methods: We retrospective review patients with distal radius fracture. Thirteen patients received surgery due to distal radius fracture nonunion or delayed union. The average age at treatment was 63 (range = 37-80) years old. Initial treatment was splinting in seven patients and surgical fixation in six patients (plate in four and external fixation in two). We reviewed preoperative and postoperative radiograph and range of motion (ROM). Fracture type, grip strength compared to contralateral hand and functional score were also recorded. Surgical procedure included debridement, realignment, bone grafting and fixation with plate. Open reduction and internal fixation (ORIF) of ulna fracture or Darrach procedure was performed to restore the congruity and stability of the distal radioulnar joint (DRUJ). Results: All patients showed radiographic union within 3 months. The average flexion arc was improved from preoperative 21.9° (range = 10-50°) to postoperative 63.8° (range = 55-85°) and extension arc was improved from preoperative 26.9° (range = 5-70°) to postoperative 67.3° (range = 60-85°) .The rotation arc (supination-pronation) was also improved form preoperative 76°(range = 30-150°) to postoperative 144° (range = 110-155°). The average percentage of the grip strength of the injured side compared to the normal side was 76.7% (range = 52-90%). One patient had excellent in functional outcome, eight with good and four with fair according to the rating system of Fernandez. Only one patient developed the complication of nonunion of the ulnar fracture. Conclusion: Surgical treatment for distal radius fracture nonunion with plating and bone grafting with additional carefully managing of associated DRUJ derangement can lead to union, salvage the wrist joint, satisfactory functional outcome and avoid wrist arthrodesis.

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