The surgical treatment of the distal metaphysic radius fractures (DMFR)

Abstract

The goal of our study was retro and prospective analysis of the results of surgical treatment of DMFR Material and methods: In Hand Surgery Department during the period of years 2011-2015 were diagnosed and treated surgically 546 patients with DMFR (male: female = 1.78: 1). The average age of 59.3 years for men and women 60.2 years, mean age 58.5 years. Predominantly rural population with a ratio of 1.5: 1. Right hand is most often traumatized to the left hand and bilateral with a ratio of 7.75: 3.75: 1. According to the classification Kapandji (K) and AO in our practice we have met the following cases: 18(3,30%) – K.I(AO:23-A2.2 - 11 ;23-A3 - 7 patients), 272(49,82%) cases– K.II(AO:23-C1.1), 51(9,34%) – K.III(AO:23-C1.3), 14(2,56%) – K.IV(AO:23-C1.2), 15(2,75%) – K.V(AO:23-B1.1 - 11 cases ;23-B1.2 – 4 cases), 7(1,28%) – K.VI(AO:23-B2.1 - 4 cases;23-B2.2 - 3; 23-B2.3 - 1 case), 8(1,47%) – K.VII(AO:23-B3.1 - 5 cases ;23-B3.2 - 1 case ;23-B3.3 - 2 cases), 8(1,47%) – KVIII(AO:23-A2.3), 80(14,65%) – K.IX(AO:23-C3), 25(4,58%) – K.X(AO:23-C2.1 - 16 cases;23-C2.2 - 7 cases ;23-C2.3 - 2 cases). According to the classification proposed by Максимов А. (2013), the viciously consolidated fracture of the radial distal metaphysis we have 48(8,79%) cases – K.11(type1 - 4 cases; type2 - 30 cases; type3 - 12 cases; type4 - 2 cases). Depending on the type of fracture, the extent of stability and impaction, the type and the tilting angle of fragments, the surgical treatment was performed by the following methods: osteosynthesis with brooches - 149(27,38%); intrafocal osteosynthesis with brooches - method Kapandji – 269(49,24%) patients; plate osteosynthesis - 67(12,23%); ligamentocapsulotaxia in external fixation appliance - 13(2,36%); corrective osteotomy – k-wire osteosynthesis – 24(4,40%); corrective osteotomy - plate osteosynthesis – 16(2,93%); osteoclasia - plate osteosynthesis – 8(1,47%); In 29(5,31%) cases was determined acute carpal tunnel syndrome, which has intervened by decompression of the median nerve. In 5(0,92%) cases K.XI (tip2,3,4) was determined carpal tunnel syndrome, the median nerve compression ultrasonography was determined in the carpal tunnel more than 18% versus proximal, was performed excision of the carpal ligament and median nerve neurolysis. Conclusion · The problem of treatment DMFR far remains current, despite of the successes in the treatment of orthopedic and experience in the treatment FMDR · In our study, most patients were treated by the method Kapandji - 269(49,24%), that ensuring a good bone junction, excluding secondary displacement. · With a minimum operator volume, exclude the risk of complications and allows a more rapid rehabilitation hand.