Comparative analysis of the effectiveness of treatment of distal radius fractures in patients in the Voronezh region.

Abstract


Annotation:

Relevance: A distal radius fracture is one of the most common fractures of the musculoskeletal system, accounting for 34% of all fractures and up to 90% of forearm fractures.

Goal: - improving the effectiveness of treatment of the distal radius.

Materials and methods: A retrospective analysis of 78 case histories of patients with distal radius fractures treated at the BUZ WAS performed VOKB No. 1 in the Department of traumatology in the period from January 2020 to December 2020. The patients ranged in age from 18 to 65 years. Terms from fractures ranged from a week to 5 months. Conservative treatment was used in 31.5% of cases (23 patients). Hospitalization and surgical treatment were required in 68.5% (56 patients). Osteosynthesis was performed with a plate, which was used in the following procedure: T-shaped, angular stability plate and foot plate.

Discussions: The greatest number of complications occurs when using a conservative method of treatment.

Results: When using the foot plate , there are no complications, the restoration of the function of the damaged limb occurred 3-4 days faster than when using the foot plate. other methods of surgical treatment.

Conclusions: The use of a paw plate combines the positive aspects of extrafocal and submerged osteosynthesis and is the optimal method of surgical treatment of DOLC fractures.

Key words:: traumatology, surgery, and fractures of the distal radius.


Full Text

Relevance: A distal radius fracture is one of the most common fractures of the musculoskeletal system, accounting for 35% of all fractures and up to 90% of all fractures of the forearm bones [1]. There is a seasonality of occurrence An increase in the frequency of PDOLK is observed in the autumn-winter period and is associated with the deterioration of weather conditions. In addition to the high frequency of occurrence, PDOLCS are characterized by a large number of complications both during conservative treatment and after surgical osteosynthesis. After conservative treatment and the application of a plaster splint , the secondary displacement of fragments occurs in 15.8-78% of cases [2]. Also quite often there is a complex regional pain syndrome which accounts for 7-30% of complications [3].

Research objective - improving the effectiveness of treatment of the distal radius.

Materials and methods: A retrospective analysis of 87 case histories of patients with PDOLK treated in BUZ was performed VOKB No. 1 in the Department of traumatology in the period from January 2020 to December 2020. The patients ranged in age from 18 to 65 years. Terms from fractures ranged from a week to 5 months. Two treatment strategies were used: conservative treatment with immobilization of the injured limb with a plaster ganglion and surgical treatment with the use of T-shaped plate, LSP- a plate and a foot plate, as well as the application of an external fixation device (ANF). Conservative treatment was used in 26.5% of cases (23 patients). After a closed reposition , unsatisfactory standing of fragments was noted in 30.4% of cases. % of cases (7 patients). Complications in the form of repeated displacement of fragments were observed in 6 patients (26% of cases). Hospitalization and surgical treatment were required in 64.4% (65 patients). Osteosynthesis was performed T-shaped plate. This operation was performed at 19 patients (29.2% of cases). Complications in the form of screw migration were observed in 4 patients (21% of cases). In addition to using The t-shaped plate was resorted to osteosynthesis LSP with a plate. LSP the plate was used in 11 patients (16.9% of cases). No complications were observed in these patients. An intra-articular fracture of the distal radius was diagnosed in 12 (18.4% of cases) patients , and a paw plate developed at the Department of traumatology and orthopedics was used to treat such fractures N. N. Burdenko VSMU (Application form: 2007100272/22, 09.01.2007). No complications were observed after using this technique. In addition to immersion osteosynthesis with a plate , an external fixation device was applied in 23 patients patients (35.6% of cases). Were used spoke, rod and combined devices. Y 5 (21.7% of cases) of patients after application ANF suppuration of soft tissues in the contact area was observed saws and rods with soft fabrics. After performing osteosynthesis with plates , patients started active movements in the wrist joint on an average of 3-4 days after pain relief. After the imposition of ANF patients were able to start active movements in the metacarpophalangeal and interphalangeal joints on 2-3 days.

Discussions: The greatest number of complications occurs when using a conservative method of treatment (30,4%). Among all surgical treatment methods treatment complications are equally common as when using osteosynthesis T-shaped plate, and when applying an external fixation device (21% and 21.7% of cases , respectively).

Results: The beginning of rehabilitation and recovery of active movements in the wrist joint is faster when using LSP plates are 1.4 times faster compared to conservative treatment and 1.2 times faster when using osteosynthesis T-shaped plate and applying the external fixation device. Complete restoration of the function of the damaged limb with the use of a foot plate on average occurs 2-3 weeks faster than with other surgical methods of treatment.

Conclusion: A plaster splint in the treatment of PDOLK does not provide reliable fixation of bone fragments and leads in 30.4% of cases to secondary displacement, as a result of which the time of General treatment increases and quite often leads to the need for surgical treatment. After surgical treatment , the function of the damaged joint is restored 1.2-1.4 times faster. The use of a paw plate allows for careful surgical intervention , while additional immobilization is not required, so it is possible to start earlier rehabilitation.

About the authors

vladimir Zolotukhin

Author for correspondence.
Email: vladimir.zolotuxin@gmail.com
ORCID iD: 0000-0002-8513-3966
SPIN-code: 3818-0447

Yana Arzhanykh

Email: yana.arzhanyh@yandex.ru
ORCID iD: 0000-0001-9064-0623
SPIN-code: 8731-9949

References

  1. Матвеев Р.П., Брагина С.В., Шнейвейс А.М. Дифференцированный подход к лечению переломов дистального метаэпифиза лучевой кости со смещением // Гений ортопедии. 2017. Том 23, № 4. P. 396-400.
  2. Способ открытой репозиции и остеосинтеза переломов дистального отдела лучевой кости / Гилев М.В., Антониади Ю.В., Волокитина Е.А., Черницын Д.Н., Цыбулько И.А., Жиряков Д.Л., Зверев Ф.Н.: патент № 2601850 Рос. Федерация. № 2015145503/14; заявл. 22.10.2015; опубл. 10.11.2015.
  3. Т-образный остеотом / Гилев М.В., Антониади Ю.В., Волокитина Е.А: патент на полезную модель № 160622 Рос. Федерация. № 2015139504/14; заявл. 17.09.2015; опубл. 27.03.2016. Бюл. № 9.

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