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Complex treatment of distal radius fractures and its consequences


Author: Alina Glavan
Degree:doctor of medicine
Speciality: 14.00.22 - Orthopedics and Traumatology
Year:2007
Scientific advisers: Vitalie (decedat) Beţişor
doctor habilitat, professor
Filip Gornea
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 18 April, 2007
Approved by NCAA on the 14 June, 2007

Abstract

Adobe PDF document0.35 Mb / in romanian

Thesis

CZU 616.717.5- 001.5

Adobe PDF document 3.98 Mb / in romanian
135 pages


Keywords

the radius distal fracture, distal radius fractures, osteoporosis, indices of osteoporosis, osteosynthesis of the radius distal fracture

Summary

Our study is based on the analysis of experience of non-operative and surgical treatment of the distal radius fractures in 322 patients, treated at the “V. Beţişor” Clinic and at the municipal ambulatory wards during the years 1999–2006. We have studied the results of clinical and paraclinical examination of patients, the osteodensitometry of the distal radius (209 patients), the determination of Garn indices (75 patients), the index of cortical thickness of radius (75 patients), the osteoporosis index (150 patients), and the study of the follow-up results in compliance with the Gartland and Werley’s score (2000) in 274 patients (85.09%).

Among the 322 examined patients, 165 have undergone non-operative treatment and 157 – surgical treatment. Among the 157 patients treated surgically, the Kapandji intrafocal osteosynthesis has been performed in 64 cases, wires osteosynthesis in 40 cases, ligamentocapsulotaxy in the Ilizarov apparatus - 29 cases, plate fixation - 24 cases.

We have developed a new method of osteoporosis determining that may be easily applied in practice. Clinical investigations have been carried out on 150 patients at the Practical Scientific National Center of Emergency Medicine. We have used as comparative method the osteodenisitometry of distal third of radius. We have determined that the data obtained in compliance with the proposed radiogrammetry for evaluation of osteoporosis degree in distal radius, in general, correlate with the data obtained through the method of osteodensitometry, which has been performed at the same patient. Moreover, it can be mentioned that the stated method rises above the known methods by precision since 4 important factors that affect the state of the bone system as a whole and the distal radius in particular are taken into consideration.

The result of the method consists in the evaluation of the criteria that is the unbiased characteristic of the bone tissue of the distal radius in order to determine the optimal treatment strategy of the distal radius fracture. We have compared the results obtained at a follow-up between 6 monts and 5 years, treated by surgical and non-operative method. The chance of having satisfactory results in patients treated by non-operative method is 2,8 times smaller than at the patients treated by surgical method. The surgical method must be granted priority in the treatment of: Kapandji intrafocal osteosynthesis, wires diafixation, plate fixation, and, in some cases, ligamentocapsulotaxy with devices of external positioning.

The summation of the follow-up outcomes of the performed treatment in 322 patients with distal radius fracture proved the following postulate: the personalized treatment depending on the patient’s sex, age, fracture features and bone fracture properties guarantee the obtaining of good results, programmed in about 80.7% cases.