[Palmar Displacement in Distal Radius Fractures following Extension Injuries of the Wrist].

IF 0.4 4区 医学 Q4 SURGERY Handchirurgie Mikrochirurgie Plastische Chirurgie Pub Date : 2024-10-21 DOI:10.1055/a-2411-9237
Christopher Selle, David Latz, Denis Friesen, Michael Schädel-Höpfner
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Abstract

Background: Fractures of the distal radius have been traditionally classified based on the suspected mechanism of injury. Among clinicians, the terms "Colles" and "Smith" fractures are commonly used to refer to a distal radius fracture that is either displaced to the dorsal (Colles) or palmar (Smith) side of the radius. When analysing x-rays, it is not uncommon for a Smith fracture to be detected in cases where patients describe a fall on the wrist in an extended position. Thus, the question arises how a flexion-type fracture can occur after an extension injury. So far, only little research has been conducted into this subject.

Material and methods: The aim of this study was to analyse the mechanisms of injury that lead to various types of distal radius fractures. Particular emphasis was placed on "Smith" fractures and on the biomechanical, physiological and anatomical characteristics that contribute to their occurrence. To assess these relationships, data of fractures were collected following a life-like fracture simulation using a "drop-bench" in non-formalin fixated human specimens. These fractures were produced between January 2016 and December 2021. Biographic data of all specimens used were available. Additionally, all biomechanical and physical characteristics of the fracture simulation were fully documented.

Results: Of the 122 specimens with a full data set, 17 (13.9%) fractures were determined to be Smith fractures based on their radiological appearance. In 10 of these flexion fractures, the wrist was set in dorsal extension. The mean angle of extension was 86.3 degrees for flexion fractures compared to 90.5 degrees for extension fractures. Six out of 10 Smith-type fractures that were set in dorsal extension were also exposed to pronation, whereas only one was exposed to supination. The mean potential energy for fracture creation was 168.0 joules for Smith fractures in dorsal extension, whereas all other fractures showed a mean of 185.2 joules.

Conclusions: It can be concluded that a Smith fracture is not limited to being the result of a fall on the wrist in a flexed position. The same fracture may also be the result of a fall with the wrist in an extended position if certain physical factors are applicable.

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[腕关节伸展损伤后桡骨远端骨折的掌侧移位]。
背景:桡骨远端骨折历来根据可疑的损伤机制进行分类。在临床医生中,"Colles "和 "Smith "骨折通常指桡骨远端骨折移位至桡骨背侧(Colles)或掌侧(Smith)。在分析X光片时,如果患者描述手腕在伸直状态下摔倒,那么发现史密斯骨折的情况并不少见。因此,问题来了,为什么伸展损伤后会发生屈曲型骨折?迄今为止,对这一问题的研究还很少:本研究旨在分析导致各种类型桡骨远端骨折的损伤机制。重点是 "史密斯 "骨折以及导致骨折发生的生物力学、生理学和解剖学特征。为了评估这些关系,研究人员使用 "跌落台 "对未固定的人体标本进行了逼真的骨折模拟,并收集了骨折数据。这些骨折发生在 2016 年 1 月至 2021 年 12 月期间。所使用的所有标本的生理学数据均可获得。此外,骨折模拟的所有生物力学和物理特征都有完整记录:在拥有完整数据集的 122 例标本中,有 17 例(13.9%)骨折根据其放射学外观被确定为 Smith 骨折。其中 10 例屈曲骨折的腕关节处于背伸状态。屈曲型骨折的平均伸展角度为86.3度,而伸展型骨折的平均伸展角度为90.5度。在背伸状态下固定的 10 例史密斯型骨折中,有 6 例也受到了前伸的影响,而只有 1 例受到了后伸的影响。背伸状态下的史密斯骨折造成骨折的平均势能为 168.0 焦耳,而所有其他骨折的平均势能为 185.2 焦耳:结论:可以得出结论,史密斯骨折并不局限于手腕在屈曲状态下摔倒所致。结论:可以得出结论,史密斯骨折并不局限于腕关节屈曲位摔倒所致,如果某些物理因素适用,腕关节伸展位摔倒也可能导致同样的骨折。
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来源期刊
CiteScore
1.00
自引率
16.70%
发文量
85
审稿时长
6-12 weeks
期刊介绍: In Originalarbeiten und Fallberichten finden Sie die neuesten Informationen über: Diagnostik Verfahrenswahl state of the art / neueste Techniken rekonstruktive Verfahren Behandlung infolge von Traumata oder OP Bewertung der Ergebnisse Klinische Forschung Interessante Darstellung der neuesten Erkenntnisse in Originalarbeiten und Fallberichten. Exzellent veranschaulicht durch ein klares Layout und reiche Bebilderung. Überzeugen Sie sich selbst! Organschaften Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie, Deutschen Gesellschaft für Handchirurgie und Österreichischen Gesellschaft für Handchirurgie Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße Organ der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen
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[Is networking in international societies dispensable in Plastic Surgery? Clear vote in favour of ESPRAS and ICOPLAST at the 54th Annual Conference of the DGPRÄC in Düsseldorf]. On occasion of the "ESPRAS - A day in Sarajevo" meeting at the 13th BAFPRAS Congress. [Postoperative Pain Level Following Surgery of the Hand and Wrist in the Ambulatory Setting]. [Palmar Displacement in Distal Radius Fractures following Extension Injuries of the Wrist]. [Dorsal Screw Osteosynthesis of a Scaphoid Nonunion associated with Congenital Scaphotrapezial and Lunotriquetral Coalitions: A Case Report].
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