Article
A new technique for the treatment of the distal ulnar fractures associated with distal radial fractures in older adults using intramedullary wiring
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Authors
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Sadaaki Tsutsui
- Showa University, Department of Orthopedics, Tokyo, Japan
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Keikichi Kawasaki
- Showa University, Yokohama Northern Hospital, Yokohama, Japan
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Katsunori Inagaki
- Showa University, Department of Orthopedics, Tokyo, Japan
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: There is no clear consensus about the optimal treatment of distal ulnar fractures associated with distal radial fractures in older people. The aim of this article is to review the impact of intramedullary Kirschner wire fixation of the distal ulna fractures associated with distal radius fracture.
Methods: 17 patients in whom a intramedullary Kirschner wire fixation was used to repair the distal ulna fractures associated with the distal radius fractures were reviewed retrospectively with minimum follow-up of 23.6 months (range, 6-42 months) after surgery. The mean age of the patients were 73.2 years and all of the patients were female.
According to the Biyani Classification of ulnar Fractures, there were 9 simple fractures of the ulnar neck (type 1), 3 T or Y shaped fractures of the ulnar head (type 2), and 4 fractures of the styloid process and neck (type 3), 1 comminuted fracture of the neck and head (type 4).
The surgical procedures were as follows: at first, the distal radius fractures were fixed rigidity with a volar locking plate. Secondly, distal ulna fractures were fixed with antegrade intra-medullary wiring from olecranon to the ulnar head. We investigated the clinical evaluation, the radiological evaluation and complications of these cases.
Result: All fracture sites displayed union, and the mean loss of reduction of the ulnar variance was 0.36mm, mean angular deformity of the distal ulna metaphysis was measured 2.5(±3.5) degrees.
The mean motion of the wrist was as follows: flexion 63.6°; extension 71.8°; pronation 85°, supination 87.9°. The Average grip strength was 88.1% of the contralateral uninjured extremity. There were no infections and no wound problems. According to the Mayo wrist score, there were 10 excellent, 5 were good, 2 were poor results at final evaluation. There was no instability of the distal radioulnar joint. 16 patients had a second operation to remove the ulnar wires.
Conclusion: For elderly patients, the fixation of distal ulna fracture associated with distal radius fracture using intramedullary wiring can achieve healing with good alignment, satisfactory function.
