Timoshenko S. Surgical treatment of unstable distal radius fractures and their consequences

The thesis is dedicated to actual problem on basis of development of diffentiated approach to tactics of surgical treatment. The analysis of 5000 everyday's complaints in traumatologic emergency showed that distal radius fractures make up 4,88% of patients , among then 36,4% of patients had unstable intra-articular fractures with considerable displacement. In 116 patients with unstable fractures (67), and pseudoarthrosis(9) comparative estimate of roengenmetric indices of reposition and functional results has been carried out according to the scales of mayo wrist score and DASH score. Biomechanical simulation of Colles' fracture has been carried out which conforms that initial dorsal displacement more than that initial dorsal displacement more than 28-31 degrees will be potentially unstable and will lead to loss of restoration. With comparative estimate of fixation methods by means of wires, in external fixations whit the aid of traditional constructions and modern specialized metal constructions, the lost one related the best results of reposition (p<0,05) and excellent functional results/ During serious and intra-articular displacements dorsal arthrotomy of joint has been carried out including application of intraoperative distractor. Developed differentiated algorithmic approach on the basis of selection of optimum surgical approach the method of fixation and the type of fixative estimate of bone plasty necessity which bring in correspondence with such features of fracture as degree and displacement direction, quantity of fragments ect. All this allows quickly to restore basic functions of hand and with confidence (p<0,001) to inprove remote results of treatment a number of recommendations allowed whith confidence to improve the results of correcting osteotomies. It was proved inadvisability of neurolys in these patients for the reason of compression neuropathy. In this case correction of upper extremity axis was sufficient. It has been noted reliable lowering of roentgenosteodensitometric indices in different zones of wrist which become worse with unstable osteosynthesis.