What is the goal of surgical treatment of elderly distal radius fractures?

Abstract

Distal radial fractures account for 14%of all extremity injuries and can occur as a result of either a high-energy trauma with probable impairme nt to the function of the upper extremity or a low-energy injury commonly seen in osteoporotic elderly.While the comminuted intra-articular distal radial fractures have always been challenging to surgeons,obtaining a stable fixation in the elderly osteoporotic bone might just be equally difficult.In the past,elderly fragility fractures of the distal radius were often treated with manipulation and casting,despite the fact that most would heal with significant shortening and malalignment.The need for a better outcome in this common fracture is recently revisited as newer methods of treatment are devised.The injection of a calcium phosphate cement such as Norian SRS using a minimally invasive technique has been shown to accelerate rehabilitation,although there seems to be little effect in the final radiological appearance.Recently,various locking screws and implants are rapidly gaining in popularity in certain regions.These implants come with screws that directly engage the plate,creating fixed angle bolts and thus offer a better fixation in the osteoporotic bone.Indeed,In the near future,an increasing number of osteoporotic wrist fractures will be treated with surger y and the time has come when we need to rethink about our treatment strategy in dealing with such a common injury.

橈骨遠端骨折占肢體創傷的14%,常見于骨質疏鬆的老年人。橈骨遠端關節內粉碎性骨折處理棘手,高齡骨質疏鬆患者的處理則更加困難。過去,高齡骨質疏鬆性橈骨遠端骨折通常采用手法復位、石膏固定治療,多數患者會出現明顯的短縮和對線不良。為了得到更好的治療效果,近來出現了許多新的治療方法。利用微創技術局部注射磷酸鈣骨水泥,如NorianSRS被證明可以加速患者的康復,盡管最終的影像學結果并沒有明顯改善。最近各種類型的帶鎖螺釘和內植物迅速普及開來。這些內植物帶有直接鎖定鋼板的螺釘,固定角度的螺栓,可以為骨質疏鬆性骨折提供良好的固定。今后需要手術處理的骨質疏鬆性橈骨遠端骨折會越來越多,我們已經到了需要反思我們治療這種常見損傷策略的時候了。