부정유합된 원위요골 골절의 수술적 치료

Abstract

Patients with distal radius fracture have serious complications more frequently than is generally appreciated. Inadequate treatment of this fractures may cause symptomatic malunions. Malunion usually heals in a position of dorsal angulation, loss of radial inclination, and radial shortening. We have followed 13 patients, who had operations for malunited distal radius fractures at Yong-dong Severance hospital. The interval between injury and operation ranged from 4weeks to 20years, with a mean of 36.5months. Eleven were men and 2 were women, the mean age was 36.4 years(range, 12-64years). One patient had been not treated, 11 patients treated by closed means, and 1 had undergone earlier surgical procedures without acceptable healing position of the fracture. Five patients underwent a open reduction and internal fixation, 6 patients had an osteotomy and internal fixation, 1 patient had an osteotomy and external fixation and 1 patient had a Sauve-Kapandji procedure alone. After the aperation about 6weeks of cast immobilization was added. All patients were followed up at an average of 12months postaperatively (range, 8months - 3years). Improvement of radial inclination, volar tilt, radial shortening was measured. Clinical results were assessed using the Cooney wrist score and deformity score. The average improvement in radial inclination was 5.9¡Æ (range, 0¡Æ-16¡Æ), volar tilt 13.5¡Æ (range, 2¡Æ-29¡Æ), and improvement in a positive ulnar variance by 3.8mm (range, 0- 15mm). The average Cooney score was 85 of 100, and the deformity score changed from 3.2 to 1.6. The complication rate was 28% including one bow string deformity, one limitation of rotation of distal radioulnar goint, one vound infection and two delayed unions. Functional improvement was notable in all patients. In malaligned distal radius fracture patients, open reduction and internal or external fixation including osteotomy offers real benefits in terms of improved movement, relief of pain and improved appearance.