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Re: неправильно срастающийся перелом дистального луча - тактика?
послал Myles Clough 30 Сентябрь 2008, 18:16
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Interesting and thoughtful post, David.
Is there anything to say that the results of (say) an osteotomy to restore the alignment are much better early (in the first few months) than later after the assessment of long term disability (1-2 years). I found the following paper and am also sending a link to its "Related Articles" Has the conclusion that the results of early osteotomy are better been supported elsewhere?
Handchir Mikrochir Plast Chir. 1992 May;24(3):145-50.Links
[Malposition of healed distal radius fracture. Indications, technique and timing of correction]
[Article in German]
Möllenhoff G, Walz M, Sistermann R.
Chirurgischen Universitätsklinik und Poliklinik, Berufsgenossenschaftlichen Krankenanstalten Bergmannsheil, Bocchum.
Typical complications of distal radius fractures include post-traumatic malalignment in about 20%. This is associated with ulno-carpal pain and impaired wrist function. Various corrective procedures have been recommended. Between 1972 and 1986, 96 patients with posttraumatic disorders after distal radius fractures underwent surgical treatment. Three different procedures were carried out: simple corrective osteotomy of the distal radius, combined correction of the radius and ulna, as well as isolated correction of the ulna (distal resection, step-cut osteotomy, hemiresection arthroplasty). 83 (86.5%) of the patients were followed up for an average of 7 years postoperatively. The functional results were evaluated according to Lidström. Excellent and good results were found in 58 (69.9%), fair in 20 (24.1%) and bad results in 5 (6.0%). The best results were mostly seen in cases with a short interval between trauma and corrective procedure. Distal ulna resection has not been performed in our department since 1986 because of poor results and concommitant wrist-instability. We recommend combined correction procedures in those patients with painful deformities within a period of no more than six to nine months after trauma. The indication should also take individual aspects such as profession, age, activities, complaints, and radiological findings into account. Signs of osteoarthrosis and wrist disorders due to severe soft tissue problems are contra-indications to any of the aforementioned correction procedures.
Myles Clough
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