Manipulative reduction of small splint fixation for distal radius fractures

? Distal radius fracture is one of the most common clinical fractures, especially in elderly osteoporotic patients. Except for a few extremely unstable comminuted fractures that must be operated on, for most distal radius fractures, the orthopedic department of our hospital adopts a unique manipulative reduction and small splint fixation, which has achieved good therapeutic results.

Fracture degree assessment and typing: distal radius fractures are divided into three types (1) colles fracture (2) Smith fracture (3) Barton fracture. After admission, the fracture type was clarified according to CR, and different types of manipulation were adopted.

In distal radius fracture, the fracture block is generally displaced in 5 directions, palmar, dorsal, radial, ulnar, and axial, by the impulse force. Articular surface collapse, rotation, and comminution are the heavy types. Articular facet steps greater than 2 millimeters will result in the development of osteoarthritis. In addition, the presence of ligamentous and neurologic injuries should be noted for specific types of fractures.

Method of repositioning: repositioning is performed under brachial plexus anesthesia. The patient lies supine, with the affected side of the upper arm abducted 60 degrees, the elbow flexed 90 degrees, and the forearm rotated forward. The thumb of both hands was placed side by side on the dorsal side of the distal end of the fracture, and the rest of the fingers were clasped at the intersection of the big and small fishes, and the assistant held the middle and upper third of the forearm of the affected limb, and then carried out extension traction to correct the shortening displacement, and maintained the traction. If the distal end of the fracture is displaced to the dorsal side, the surgeon holds the distal end of the fracture tightly and bends the affected wrist palmarly to correct the dorsal displacement; if the distal end of the fracture is displaced to the palmar side, the surgeon holds the distal end of the fracture tightly and extends the affected wrist dorsally to correct the palmar side displacement. Finally, the distal end of the fracture is ulnar deviated to restore the ulnar deviation angle. The fracture is fixed with 4 splints, the proximal end of which reaches the upper middle third of the forearm, the distal end of the radial splint exceeds the transverse carpal tunnel by 2 cm, the distal end of the ulnar splint reaches the transverse carpal tunnel, and the palmar and dorsal splints reach the metacarpophalangeal joints. After repositioning, the wrist joint was fixed in a neutral position with mild ulnar deviation, and a bandage was wrapped with moderate force to prevent loosening. A bedside film was taken to check the alignment of the fracture.

? Special attention: try to reset the fracture successfully at one time to restore the length of the radius and the angle of inclination of the metacarpal. Check for nerve damage and grip strength after reduction. Accurately assess the severity of the fracture. Fractures that severely affect the stability of the wrist joint and are difficult to achieve accurate anatomical repositioning and fixation by manipulation require prompt surgical treatment.

? Treatment after fixation: After fixation, the metacarpophalangeal joints and interphalangeal joints should be used for active flexion and extension exercises, and the blood flow of the injured limb should be observed for 24 to 48 hours. The patient is instructed to carry out active functional exercises step by step, to promote the venous and lymphatic return of the affected limb through muscle contraction, to promote the swelling to subside, and to prevent muscle atrophy and joint adhesion or stiffness. 2 to 3 weeks later, the shoulder and elbow joints began to functionally exercise, and 6 weeks later, remove the splints, and carry out the functional exercises of the wrist joints and the forearm rotational exercises. During the period of immobilization, the tightness of the splint was adjusted according to the swelling of the limb. Periodically, the fracture should be reexamined on the 3rd, 7th, 14th, 28th, 35th, or 42nd day after the reset, and radiographs should be taken to check the alignment of the fracture.

Comprehensive attention before and after repositioning: (1) adequate anesthesia to reduce pain-induced muscle spasms, so as to facilitate repositioning; (2) the technique should be skillful and gentle, to avoid further damage to the soft tissues or nerve injury; (3) improve the necessary examination before repositioning, especially for the elderly, especially for patients with heart disease and hypertension, so as to reduce the risk of repositioning; (4) do a good job of management of splinting after repositioning, and adjust the splinting tightness at any time. The management of the splint, adjust the tightness of the splint at any time, to maintain safe and effective immobilization; (5) early informed and urged patients to carry out effective functional exercises.

Effectiveness of follow-up evaluation: The Department of Orthopaedics of our hospital observed all the cases of distal radius fracture through manipulation, and found that the therapeutic effect is more satisfactory. The treatment of distal radius fracture by manipulation and small splint fixation is characterized by simple method, small re-injury to the fracture and soft tissue, which is conducive to fracture healing, and there is no infection that may occur in the surgical treatment, which may affect the fracture healing, and the failure of internal fixation, etc. The treatment results are satisfactory even after good reduction. Satisfactory wrist function can still be obtained after good reduction, and the patient benefit and satisfaction are high.

The vast majority of distal radius fractures occur in the elderly, mostly due to falls. Therefore, increasing physical exercise, maintaining mental activity, treating related diseases, avoiding the application of inappropriate medications, and guarding against indoor and outdoor falls are all knowledge that must be generalized with patients and their families. Once a fall suspected fracture near the wrist, to the hospital orthopedic consultation, not to mention do not knead the affected area, increase the injury edema, to the follow-up treatment to bring more difficulties.

Written by zhangxue