Valoración de resultados en fracturas de radio distal operadas

de la Torre, M.; Moreno, N.; Luis, R.; Romero, A.; Moya, A.

doi:10.1016/S1888-4415(06)76413-X

Información del artículo

Resumen

Bibliografía

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Estadísticas

Objetivo

Evaluar los resultados clínicos y radiográficos de una serie de fracturas de radio distal operadas y determinar los parámetros clínicos mejor valorados por los pacientes.

Material y método

Estudio casos control de 58 fracturas de radio distal (56 pacientes) operadas entre los años 2000 y 2003. Se evaluaron fuerza, dolor, movilidad de muñeca, se analizaron radiográficamente las articulaciones radiocarpiana y radiocubital distal y se cumplimentó el cuestionario DASH (Disability of the Arm, Shoulder and Hand).

Resultados

Las fracturas de radio distal de alta energía se asociaron con pérdidas tempranas de reducción y sexo masculino, y las de baja con mujeres posmenopáusicas. La osteosíntesis empleada comprendió agujas, placas, fijación externa y combinaciones de las tres. Obtuvieron buena puntuación en el cuestionario valores bajos de la escala analógica visual y altos de pronosupinación, y esta última se asoció a varianzas cubitales negativas o poco positivas.

Conclusiones

Una amplia pronosupinación y poco dolor fueron las variables mejor valoradas por los pacientes. Por eso creemos necesario proteger la articulación radiocubital distal con independencia del estado de la radiocarpiana.

Palabras clave:

radiodistal

fractura

DASH

Purpose

Clinical and X-ray assessment of the results of a series of surgeries of the distal radius and of the clinical parameters considered of greatest value by patients.

Materials and methods

A study was carried out of 58 fractures of the distal radius (56 patients) that underwent surgery from 2000 to 2003. An evaluation was made of strength, pain, wrist mobility and of x-rays of the radiocarpal and distal radiocubital joints, and a DASH (Disability of the Arm, Shoulder and Hand) questionnaire was completed.

Results

High-energy distal fractures of the radius are associated with early loss of reduction and male sex and low energy ones with menopause and female sex. The methods of fixation used included k-wires, plates, external fixation and combinations of all of these. In the questionnaire good scores were obtained by low analogical visual values and high pronosupination values. The latter being associated with negative or slightly positive values of cubital variance.

Conclusions

Little or no pain and good pronosupination were the variables most valued by the patients. Therefore, we think it is necessary to protect the distal radiocubital joint whatever the status of the radiocarpal joint.

Key words:

distal radius

fracture

DASH

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Bibliografía

[1.]

P.C. Amadio.

What's new in hand surgery.

J Bone Joint Surg Am, 86A (2004), pp. 442-448

[2.]

P.M. Simic, A.J. Weiland.

Fractures of the distal aspect of the radius: changes in treatment over the past two decades.

J Bone Joint Surg Am, 85A (2003), pp. 552-564

[3.]

D.L. Fernández, J.B. Jupiter.

Epidemiology, Mechanism, Classification.

Fractures of the distal radius. A practical approach to management 2nd ed, pp. 23-52

[4.]

R.S. Rosales, E. Benseny Delgado, I. Díaz de la Lastra-Bosch.

Evaluation of the spanish versión of the DASH and carpal tunnel syndrome health-related quality of life instruments: Cross-cultural adaptation process and reliability.

J Hand Surg, 27 (2002), pp. 334-343

[5.]

J.L. Orbay, D.L. Fernández.

Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient.

J Hand Surg, 29 (2004), pp. 96-102

[6.]

D.J. Bozentka, P.K. Beredjjkilian, D. Westawski, D.R. Steinberg.

Digital radiographs in the assesment of distal radius fracture parameters.

Clin Orthop Relat Res, 397 (2002), pp. 409-413

Medline

[7.]

T. Lindau, C. Adlercreutz, P. Aspenberg.

Cartilage injuries in distal radial fractures.

Acta Orthop Scand, 74 (2003), pp. 327-331

http://dx.doi.org/10.1080/00016470310014265 | Medline

[8.]

M. Llusá, P. Forcada, A. Carrera, D. Pacha, R. Morro, X. Mir.

Anatomía quirúrgica y vías de abordaje de la extremidad distal del radio.

Rev Ortop Traumatol, 47 (2003), pp. 21-26

[9.]

J.L. Orbay, I. Indriago, A. Badia, R.K. Khouri, L. Osorio, J.A. Núñez, et al.

Osteosíntesis volar para las fracturas distales de radio.

Rev Ortop Traumatol, 47 (2003), pp. 42-47

[10.]

C.A. Lill, J. Goldham, A. Albrecht, F. Eckstein, C. Gatzka, E. Schneider.

Impact of bone density on distal radius fracture patterns and comparison between five different fracture classification.

J Orthop Trauma, 17 (2003), pp. 271-278

Medline

[11.]

C.F. Young, A.M. Nanu, R.G. Checketts.

Seven year outcome following Colles' type distal radial fracture. A comparison of two treatment methods.

J Hand Surg Br, 28B (2003), pp. 422-426

[12.]

X. Mir, J. Font, G. Pidemunt, A. Lluch, G. Castaldini.

Lesiones cápsuloligamentosas y óseas asociadas a las fracturas distales del radio.

Rev Ortop Traumatol, 47 (2003), pp. 48-54

[13.]

A. Beumer, M. Mc Queen.

Fractures of the distal radius in low-demand elderly patients.

Acta Orthop Scand, 74 (2003), pp. 98-100

http://dx.doi.org/10.1080/00016470310013743 | Medline

[14.]

C.A. Goldfarb, Y. Yin, L. Gilula, A.J. Fisher, M.I. Boyer.

Wrist fractures: what the clinician wants to know.

Radiology, 219 (2001), pp. 11-28

http://dx.doi.org/10.1148/radiology.219.1.r01ap1311 | Medline

[15.]

K.D. Werber, F. Raeder, R.B. Brauer, S. Weiss.

External fixation of distal radial fractures: four compared with five pins.

J Bone Joint Surg Am, 85A (2003), pp. 660-666

[16.]

D.S. Ruch, C. Yang, B.P. Smith.

Results of palmar plating of the lunate facet combined with external fixation for the treatment of high energy compression fractures of the distal radius.

J Orthop Trauma, 18 (2004), pp. 28-32

Medline

[17.]

K. Swan, J.T. Capo, V. Tan.

Distal radius plating options.

Curr Opin Orthop, 14 (2003), pp. 238-244

[18.]

D.A. Campbell.

Open reduction and internal fixation of intraarticular and unstable fractures of the distal radius using the AO distal radius plate.

J Hand Surg Br, 25 (2000), pp. 528-534

http://dx.doi.org/10.1054/jhsb.2000.0485 | Medline

[19.]

H. Drobetz, E. Kutscha-Lissberg.

Osteosynthesis of distal radial fractures with a volar locking screw plate system.

Int Orthop (SICOT), 27 (2003), pp. 1-6

[20.]

J.K. Krishnan, E.R. Wigg, R.W. Walker, J. Slavotinek.

Intra-articular fractures of the distal radius: a prospective randomised controlled trial comparing static bridging and dynamic nonbridging external fixator.

J Hand Surg Br, 28 (2003), pp. 417-421

Medline

[21.]

R. Letsch, M. Infanger, J. Schmidt, H.J. Kock.

Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position.

Arch Orthop Trauma Surg, 123 (2003), pp. 333-339

http://dx.doi.org/10.1007/s00402-003-0538-4 | Medline

[22.]

P.U. Dijkstra, J.W. Groothoff, H.J. Ten Duis, J.H. Geertzen.

Incidence of complex regional pain syndrome type 1 after fractures of the distal radius.

Eur J Pain, 7 (2003), pp. 457-462

Medline

[23.]

A. Ovidiou.

Management of complication of distal radius and ulna fractures.

J Bone Joint Surg Br, 84B (2002), pp. 358-359

[24.]

L.M. Kupersmith, S.B. Weinfeld.

Acute volar and dorsal compartment syndrome after a distal radius fracture: a case report.

J Orthop Trauma, 17 (2003), pp. 381-385

[25.]

J.O. Romanillos, E.C. Rodríguez-Merchán.

Fracturas de radio distal: ¿hay evidencias científicas de cuál es su mejor tratamiento?.

Rev Ortop Traumatol, 47 (2003), pp. 86-100

[26.]

J.L. Marsch, J. Buckwalter, R. Gelberman, D. Dirschl, S. Olson, T. Brown, et al.

Articular fractures: does an anatomic reduction really change the result?.

J Bone Joint Surg Am, 84A (2002), pp. 1259-1271

[27.]

D.L. Fernández.

Should anatomic reduction be pursued in distal radial fractures?.

J Hand Surg Br, 25B (2000), pp. 523-527

[28.]

J.D. Gliatis, S.J. Plessas, R.C. Davis.

Outcome of distal radial fractures in young adults.

J Hand Surg Br, 25B (2000), pp. 535-543

[29.]

S. Batra, A. Gupta.

The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures.

Injury, 33 (2002), pp. 499-502

Medline

[30.]

J. Leone, M. Bhandari, A. Adili, S. Mc Kenzie, J.K. Moro, R.B. Dunlop.

Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures.

Arch Orthop Trauma Surg, 124 (2004), pp. 38-41

http://dx.doi.org/10.1007/s00402-003-0597-6 | Medline

[31.]

I.A. Karnezis, E.G. Fragkiadakis.

Association between objective clinical variables and patient-rated disability of the wrist.

J Bone Joint Surg Br, 84B (2002), pp. 967-970

[32.]

J.C. Mc Dermid, A. Donner, R.S. Richards, J.H. Roth.

Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture.

J Clin Epidemiol, 55 (2002), pp. 849-854

Medline

[33.]

N. Hollevoet, R. Verdonk.

Outcome of distal radius fractures in relation to bone mineral density.

Acta Orthop Belg, 69 (2003), pp. 510-514

Medline

[34.]

M.M. May, K.Y. Lexington, J.N. Lawton, P.E. Blazar.

Ulnar styloid fractures associated with distal radius fractures: Incidence and implications for distal radioulnar joint instability.

J Hand Surg, 27 (2002), pp. 965-971

[35.]

T. Lindau, P. Aspenberg.

The radioulnar joint in distal radial fractures. A review.

Acta Orthop Scand, 73 (2002), pp. 579-588

http://dx.doi.org/10.1080/000164702321022884 | Medline

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