Clinical investigation of conservative treatment for volar Barton fracture / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the indication and outcome of volar Barton fracture treated by nonoperative method.</p><p><b>METHODS</b>Twenty-three cases of volar Barton fracture treated by closed method included 8 male and 15 female with an average age of 52.2 years,ranging 16 to 84 years. Among them, 16 cases showed subluxation of the carpus (15 cases were Mehara type I ,1 case was Mehara type III) by radiographs except the other 7 cases. By the experimentation in 32 cadavers, the injury of dorsal radiocarpal ligament was supposed to be a very important cause of the subluxation of the radiocarpal joint. The criteria of Pattee and Thompson was used to evaluate the outcome of the treatment.</p><p><b>RESULTS</b>Twenty-three patients were followed up for 7 to 70 months, 11 cases gained satisfactory outcome (1 case as excellent, 10 cases as good), 12 cases gained unsatisfactory outcome (5 cases as fair, 7 cases as poor). Five of 7 cases without the subluxation of the carpus by the radiographs gained satisfactory outcome. Six of 16 cases with the subluxation of the carpus gained satisfactory outcome.</p><p><b>CONCLUSION</b>(1) The result of reduction will influence the outcome of the treatment, the step on articular surface shoud be less than 2 mm after reduction. (2) Nonoperative method is recommended if volar Barton fractures are not associated with subluxation of the carpus. (3) Nonoperative method can be tried first if the fractures associated with the subluxation of the carpus, however operation is recommended when the articular step is more than 2 mm.</p>

The role of CT in the diagnosis and treatment of distal radius fracture / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate and discuss the role of CT in the diagnosis and treatment of comminutive distal radius fractures.</p><p><b>METHODS</b>One hundred and eleven consecutive patients (118 cases of fractures) who were admitted to Jishuitan hospital from January 2003 to January 2005 were included in this study. These patients all need operative treatment and accepted CT scans for better understandings of these injuries and helping to make operation plans.</p><p><b>RESULTS</b>after comparing the results of X planes and CT scans, considerable differences existing between the two examinations were found in the measurements of articular compression and step-off, gapping, comminution degree and subdislocation. This difference was manifested not only in the alteration of quantity but also in the change of quality.</p><p><b>CONCLUSIONS</b>Computed tomography can provide more vivid and detailed information of fractures for practitioners. Undoubtedly, CT is especially valuable in the evaluation of severity degree and stability of comminutive distal radius fractures, thus it helps us to determine whether operation is obligatory and choose the best method and approach of operation. Moreover, CT can also clearly show the important parts of fractures which need special attention in the process of operation. At the same time, practitioners are required to understand the indications of CT examination completely and know how to choose scan planes properly.</p>

Selection of dorsal or volar internal fixation for unstable distal radius fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the results of T-plate in the treatment of unstable distal radius fractures.</p><p><b>METHODS</b>Dorsal or volar T-plate fixation was used for unstable distal radius fractures according to different types of fracture. For comminuted fractures with severe cortex destruction and insufficient buttress, artificial bone graft or autograft was adopted to restore local stability.</p><p><b>RESULTS</b>Satisfactory reduction was achieved after surgery. Functional rehabilitation under surveillance began from the 2nd or 3rd post-operative day. The overall excellent or good recovery rate was 90.77% after a mean follow-up of 29.63 months. For the 55 sides of volar fixation (30 sides with a dorsal displacement fragment), excellent or good recovery rate was 92.72%. Dorsal fixation was used in delayed cases (> 6 weeks) or certain fracture patterns unsuitable for volar approach. The excellent on good recovery rate was 77.77%.</p><p><b>CONCLUSIONS</b>Volar approach is an ideal option not only for distal radius fracture with a volar displaced fragment but also for dorsal displaced fractures (Colles' fracture). The advantages of this approach include flat cortex for easy plate fixation, better tension band effect, less soft tissue destruction, leaving dorsal soft tissue hinge intact, and avoiding bone graft leakage. Satisfactory results can be obtained in those patients with unstable distal radius fracture through volar approach plate fixation, especially in those with fresh fractures. If possible, volar approach can also be used in delayed fractures within 6 weeks. The results of dorsal fixation is a little bit inferior.</p>