桡骨远端骨折三柱理论.pdf

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1、FRACTURESOFTHEDISTALENDOFTHERADIUSTREATEDBYINTERNALFIXATIONANDEARLYFUNCTIONAPRELIMINARYREPORTOF20CASESDANIELA.RIKLI,PIETROREGAZZONIFromtheUniversityHospital,Basel,Switzerlandracturesofthedistalendoftheradiusshouldbeening.Malalignmentresultsinlimitationofmov

2、ementFtreatedonthesameprinciplesasotherfractures(Fernandez1993),changesinloaddistribution(Shortetalinvolvingjoints.Displacedarticularfracturesrequire1987),midcarpalinstability(TaleisnikandWatson1984)openreductiontoallowanatomicalreconstructionofandanincreas

3、edriskofosteoarthritisoftheradiocarpalboththeradiocarpalandtheradio-ulnarjoints.Forjoint.Radiallengthisalsoanimportantprognosticfactorextra-articularfractureswithseverecomminutionand(AroandKoivunen1991;Trumble,SchmittandVeddershorteningthisenablestheradiall

4、engthtobe1994);lossresultsinapainfulrestrictionofrangeofre-establishedachievingradio-ulnarcongruency.movementduetoincongruencyofthedistalradio-ulnarStableinternalfixationcanbeachievedwithtwo2.0joint,impingementofthetriangularfibrocartilageandsub-AOtitaniumpla

5、tesplacedoneachofthe‘lateral’andluxationoftheulnarheadleadingtodegenerativearthritisthe‘intermediate’columnsofthewristatanangleof(Fernandez1988;Hagert1994).50°to70°.ThisgivesgoodstabilitydespitethetinyIntra-articularfractures(AOtypesBandC)withastepdimension

6、softheplates,andallowsearlyfunction.ofover2mmintheradiocarpaljointinevitablyresultinWereportaseriesof20fracturestreatedbythisosteoarthritisandfunctionalimpairment(KnirkandJupitermethodofinternalfixationwithsatisfactoryresultsin1986).Itisthereforeimportanttor

7、econstructthejointall.surfaceandmakeitcongruent,andmanymethodsofreconstructingtheradiocarpaljointhavegivengoodresultsJBoneJointSurg[Br]1996;78-B:588-92.Received12December1995;Accepted25January1996(Melone1986;Axelrodetal1988;Bradway,AmadioandCooney1989;Ferna

8、ndezandGeissler1991;JupiterandLipton1993).TheworkofFrykman(1967)showedthattheradio-ulnarjointisanimportantfactorinthetreatmentofThemanagementoffracturesofthedistalendoftheradiusfracturesofthedistalendo