Case 28 4
0. 482
CooneyScore
95. 1 90. 4
IIIVVV...고고고찰찰찰
의 하중 배분에 영향을 주어 월상골 관절면의 압력을 높인다고 보고 따라,Sauve-Kapandji,Darrach,Bower's술식 같은 원위 척골에 대 한 수술이 같이 행해지기도 한다15,21. 본 연구에서도 교정 절골술 후
에도 원위 요척 관절의 회복에 실패해 추가적으로 Sauve-Kapandji
판 내고정물과의 마찰로 인한 건파열,복합부위통증 증후군 등이 있 을 수 있다3,8,24본 연구에서는 수장측 금속판과의 마찰로 인한 장무지 굴건의 파열로 건봉합술을 시행했던 1례가 있었으나 다른 합병증은 관찰되지 않았다.
V VV...결결결론론론
결론으로 저자는 본 연구를 통해서 원위 요골 골절 부정 유합 환자의 수술적 치료 결과에 좋은 예후 인자는 방사선학적으로 초기 척골 변 이가 적은 경우,젊은 나이,초기 골절이 관절외 골절인 경우,수상 후 8주 이내에 수술한 경우 등임을 알 수 있었다.
원위 요골 골절의 부정 유합은 그 발생의 예방이 중요하나 동통과 기 능 제한이 동반된 원위 요골 부정 유합에 대해서는 술전의 치밀한 계 획과 세심한 수술 술기를 이용한 요골 절골술과 더불어 내고정술 또 는 외고정술을 시행하여 원위 요골 관절면의 방향의 회복,요수근 관 절의 부하전달의 정상화,중수근 관절 및 요수근 관절의 역학적 운동 의 정상화,원위 요척관절의 해부학적 복원을 통하여 동통의 감소와 기능의 회복을 통해 술전에 비해 술후 만족할 만한 결과를 얻을 수 있다.
참
참참고고고 문문문헌헌헌
1.Fernandez DL Correction ofposttraumatic wristdeformity in adultsbyosteotomy,bonegrafting andinternalfixation.JBone JointSurg1982;64A:1164-1178.
2.FlinkkilaT,Raatikainen K,KaarelaO Correctiveosteotomy for malunion of the distal radius Arch Orth Trauma Surg 2000;120:23-26.
3. Jupitor JB, Ring D A comparison of early and late reconstruction ofthe distalend ofthe radius.J Bone Joint Surg1996;78A:739-748.
4.PrommersbergerKJ,vanSchoonhovenJ,LanzU Out comeaftercorrectiveosteotomyformalunitedfracturesof thedistalendoftheradius.JHandSurg[Br]2002;27:55-60.
5.FernandezDL,JupitorJB,GonzalezE Correctiveosteotomy for symptomaticincreasedulnartiltofthedistalendoftheradius.
JHandSurg2001;26A:722-732.
6.Fernandez DL,Ring D,Jupiter JB Surgicalmanagement of delayed union and nonunion ofdistalradius fractures.JHand Surg2001;26A:201-209.
7.Jenkins NH,Mintowt-Czyz WJ Mal-union and dysfunction in Colles’'fracture.JHandSurg[Br]1988;13:291-293.
8.JupiterJB,RingD,WeitzelPP Surgicaltreatmentofredisplaced fracturesofthedistalradiusin patientsolderthan 60years.J HandSurg2002;27A:714-723.
9.PogueDJ,ViegasSF,PattersonRM Effectsofdistal radiusfracturemaluniononwristjointmechanis.JHand SurgAm 1990;15:721–727.
10.AdamsBD,GroslandNM,Murphy DM,McCulloughM Impact
of impaired wrist motion on hand and upper-extremity performance.JHandSurg2003;28A:898-903.
11.CooneyWP Fracturesofthedistalradius.In:CooneyWP, LinscheidRL,DobynsJH,editors.Thewrist:diagnosisand operativetreatment.St.Louis,Mosby;1998.p.315-316.
12. Carter PB, Stuart PR The Sauve-Kapandji procedure for posttraumaticdisorders ofthedistalradio-ulnarjoint.JBone JointSurg2000;82B:1013-1018.
13.Fernandez DL Radialosteotomy and Bowers arthroplasty for malunited fractures ofthe distalend ofthe radius.J Bone JointSurg1988;70A:1538-1551.
14.HastingsH,WeissAP,QuenzerD Arthrodesisofthewristfor post-traumaticdisorders.JBoneJointSurg1996;78A:897-902.
15. Zimmermann R, Gschwentner M, Arora R. Treatment of distal radioulnar joint disorders with a modified Sauve-Kapandji procedure: Long-term outcome with special attention to the DASH Questionnaire.Arch Orthop Trauma Surg2003;123:293-298.
16. Young BT, Rayan GM Outcome following nonoperative treatmentofdisplaced distalradius fractures in low-demand patientsolderthan60years.JHandSurg2000;25A:19-28.
17.Watson HK,CastleJrTH Trapezoidalosteotomy ofthedistal radius for unacceptable articular angulation after Colles' fracture.JHandSurg1988;13A:837-843.
18.DePalmaAF Comminutedfracturesofthedistalendof theradiustreatedbyulnapinning.JBoneJointSurgAm 1952;34:651-652.
19.Orbay JL,Indriago I,Badia A O Corrective osteotomy of
dorsally mal-united fractures of the distal radius via the extendedFCR approach.JHandSurg2003;28A:204-211.
20.KnirkJL,JupiterJB Intraarticularfracturesofthedistalendof theradiusinyoungadults.JBoneJointSurg1986;68A:647-659.
21.Shea K,DL DLF,JupiterJB,Martin C Corrective osteotomy formalunited,volarly displaced fractures ofthe distalend of theradius.JBoneJointSurg1997;79A:1816-1826.
22.Ring D,Jupiter JB,Brennwald J,Buchler U,Hastings H Prospective multicentertrialofa plate fordorsalfixation of distalradiusfractures.JHandSurg1997;22A:777-784.
23.Ring D,Roberge C,Morgan T,Jupiter JB Comparison of structural and non-structural bone graft for corrective osteotomy of distal radius malunion. J Hand Surg 2002;27A:216-222.
AAAbbbssstttrrraaacccttt
Fracture malunions of distalradius represent one of the most common complication of distalradius fracture.The radiographic parameters used to describe the malunion are dorsal or volar angulation, radial shortening, radial inclination, and rotational deformity.Acceptablevaluesforsatisfactoryreductionvarygreatly.
Mostauthorsagreethatradialshortening morethan 5 mm leads to unsatisfactory outcomes. Loss of normal radial inclination contributes to the cosmetic deformity of the wrist,with more severe loss of inclination leading to decreased grip strength.
Disabling limitation ofulnardeviation occurs with severe loss of radial inclination of 20 or greater. The symptomatic malunion causes pain,limitation ofwristmotion,arthritis,decrease ofgrip power,wrist instability,attritionaltendon rupture,carpaltunnel
syndrome and cosmetic problems.Prevention ofthe malunion is the best treatment.But it occurs to the patients in whom a medicalillnessprecipitatedafallandlife-saving medicalcaretook precedenceovertreatmentofamusculoskeletalinjury.Inthatcase corrective osteotomy is needed.The purpose ofthis retrospective study isfortheresultofoperativetreatmentand analysisofthe prognostic factors in the distal radius fracture malunion.
Thirty-fourpatients were reviewed aftercorrective osteotomy for symptomatic distalradius malunion.The intervalbetween injury and operation ranged from 3weeks to 60weeks,with a mean of 17.3 weeks.Twenty two weremen and twelvewerewomen,the mean age was 44.5 years(range,17-70years). Restoration of anatomy and function was assessed compared with the contralateral wrist. Nineteen patients underwent a dorsal open wedgeosteotomy and bonegraft,14patientshad an palmaropen wedge osteotomy and internal fixation, 1 patient had an intraarticular osteotomy and internalfixation and 2 patients had additional Sauve-Kapandji procedure as salvage operation.
Improvementofradialinclination,volar tilt,ulnar variation was measured.Clinicalresults was assessed using the Cooney wrist score and deformity score.Atthe finalfollow-up,the range of motion was improved. Supination improved from mean of 41 degreetomean of69degrees.Theaverageimprovementin radial inclination was 12.6 °,volar tilt 12.1 ° and improvement in a positiveulnarvarianceby3.1mm. TheaverageCooneyscorewas 91.5of100and thedeformity scorechanged from 3.2to1.4after operation.There was no statistic meaningfuldifference ofclinical resultsinsex,treatmentmodalityofdistalradiusmalunion.Young
age,extraarticlar malunion,early operation within 8 weeks from trauma areconsidered meaningfulfactors.Therewasonecaseof attritionalruptureofflexortendon asacomplication.Weconclude that reconstructive procedures in patients with distal radius malunion may not completely restore normalfunction,but can improvehandandwristfunctionandreliefofpain,andIsay that good prognosticfactorsin distalradiusmalunion arelesserradial shortening,younger age,group ofyounger age and less severe injury in initialevent(Frykman type IIand AO type A).Every effort should therefore be made to prevent malunion in the treatmentofdistalradiusfractures.
Key words: Distal radius fracture, Malunion, Osteotomy,Prognosticfactor