PDF(Pubmed)
Abstract：
BACKGROUND: To describe the surgical technique of non-compressive intramedullary threaded nail (IMTN) fixation of distal ulnar neck fractures and present the clinical and radiographic outcomes of four patients treated with this novel technique.
METHODS: At a single Level 1 Trauma Center, a retrospective review was conducted for patients with distal ulnar neck fractures treated with retrograde IMTN between 2022 and 2024. Exclusion criteria included inadequate follow-up. A single surgeon performed all procedures using percutaneous retrograde IMTN fixation through the central disc of the triangular fibrocartilage complex (TFCC). Patients initiated a range of motion (ROM) protocol two weeks post-operatively. Post-operative radiographic images were used to calculate the ratio of IMTN diameter to the distal ulnar medullary isthmus diameter proximal to the fracture site. Radiographic changes in displacement, angulation, and ulnar variance were calculated between the first and last follow-up radiographs. Functional outcomes including grip strength and ROM were collected.
RESULTS: Four patients with distal ulnar neck fractures were treated with retrograde IMTN between 2022 and 2024. They were followed for a minimum of three months post-operatively. All were female with an average age of 65 years. All distal ulna fractures were associated with operatively treated intraarticular distal radius fractures. All patients were treated with 75 mm length and 4.5 mm diameter IMTNs. IMTN-to-Isthmus ratio was greater than 60% in all cases. Average radiographic displacement and angulation were unchanged at the final follow-up. The average ulnar variance increased by 1.2 mm. At the final follow-up, there were no post-operative complications. No cases demonstrated ulnar-sided wrist pain, nonunion, or required revision surgery.
CONCLUSIONS: Retrograde IMTN fixation is a novel surgical technique for the treatment of distal ulnar neck fractures. We found limited but promising post-operative radiographic and functional outcomes in our patients without reported ulnar-sided wrist pain, nonunion, or need for hardware removal.
METHODS: At a single Level 1 Trauma Center, a retrospective review was conducted for patients with distal ulnar neck fractures treated with retrograde IMTN between 2022 and 2024. Exclusion criteria included inadequate follow-up. A single surgeon performed all procedures using percutaneous retrograde IMTN fixation through the central disc of the triangular fibrocartilage complex (TFCC). Patients initiated a range of motion (ROM) protocol two weeks post-operatively. Post-operative radiographic images were used to calculate the ratio of IMTN diameter to the distal ulnar medullary isthmus diameter proximal to the fracture site. Radiographic changes in displacement, angulation, and ulnar variance were calculated between the first and last follow-up radiographs. Functional outcomes including grip strength and ROM were collected.
RESULTS: Four patients with distal ulnar neck fractures were treated with retrograde IMTN between 2022 and 2024. They were followed for a minimum of three months post-operatively. All were female with an average age of 65 years. All distal ulna fractures were associated with operatively treated intraarticular distal radius fractures. All patients were treated with 75 mm length and 4.5 mm diameter IMTNs. IMTN-to-Isthmus ratio was greater than 60% in all cases. Average radiographic displacement and angulation were unchanged at the final follow-up. The average ulnar variance increased by 1.2 mm. At the final follow-up, there were no post-operative complications. No cases demonstrated ulnar-sided wrist pain, nonunion, or required revision surgery.
CONCLUSIONS: Retrograde IMTN fixation is a novel surgical technique for the treatment of distal ulnar neck fractures. We found limited but promising post-operative radiographic and functional outcomes in our patients without reported ulnar-sided wrist pain, nonunion, or need for hardware removal.
摘要：
背景：描述非压缩性髓内螺纹钉（IMTN）固定远端尺骨颈骨折的手术技术，并介绍使用这种新技术治疗的四名患者的临床和影像学结果。
方法：在一个1级创伤中心，我们对2022~2024年间逆行IMTN治疗的尺颈远端骨折患者进行了回顾性研究.排除标准包括随访不足。一名外科医生通过三角形纤维软骨复合体（TFCC）的中央盘使用经皮逆行IMTN固定进行所有手术。患者在手术后两周开始了一系列运动(ROM)方案。术后X线图像用于计算IMTN直径与骨折部位近端尺骨峡部直径的比率。位移的射线照相变化，成角,在第一次和最后一次随访的射线照片之间计算尺骨方差。收集包括握力和ROM在内的功能结果。
结果：在2022年至2024年之间，4例尺骨颈远端骨折患者接受了逆行IMTN治疗。术后随访至少三个月。均为女性，平均年龄65岁。所有尺骨远端骨折均与手术治疗的桡骨远端关节内骨折相关。所有患者均接受75mm长度和4.5mm直径IMTNs治疗。在所有情况下，IMTN与峡部的比率均大于60％。在最后的随访中，平均射线照相位移和角度没有变化。尺骨平均方差增加1.2mm。在最后的后续行动中，无术后并发症.没有病例显示尺侧腕关节疼痛，骨不连,或需要翻修手术。
结论：逆行IMTN内固定术是治疗远端尺骨颈骨折的一种新的手术技术。我们发现，我们的患者在没有报告尺侧腕关节疼痛的情况下，术后影像学和功能结果有限，但有希望。骨不连,或需要拆卸硬件。
方法：在一个1级创伤中心，我们对2022~2024年间逆行IMTN治疗的尺颈远端骨折患者进行了回顾性研究.排除标准包括随访不足。一名外科医生通过三角形纤维软骨复合体（TFCC）的中央盘使用经皮逆行IMTN固定进行所有手术。患者在手术后两周开始了一系列运动(ROM)方案。术后X线图像用于计算IMTN直径与骨折部位近端尺骨峡部直径的比率。位移的射线照相变化，成角,在第一次和最后一次随访的射线照片之间计算尺骨方差。收集包括握力和ROM在内的功能结果。
结果：在2022年至2024年之间，4例尺骨颈远端骨折患者接受了逆行IMTN治疗。术后随访至少三个月。均为女性，平均年龄65岁。所有尺骨远端骨折均与手术治疗的桡骨远端关节内骨折相关。所有患者均接受75mm长度和4.5mm直径IMTNs治疗。在所有情况下，IMTN与峡部的比率均大于60％。在最后的随访中，平均射线照相位移和角度没有变化。尺骨平均方差增加1.2mm。在最后的后续行动中，无术后并发症.没有病例显示尺侧腕关节疼痛，骨不连,或需要翻修手术。
结论：逆行IMTN内固定术是治疗远端尺骨颈骨折的一种新的手术技术。我们发现，我们的患者在没有报告尺侧腕关节疼痛的情况下，术后影像学和功能结果有限，但有希望。骨不连,或需要拆卸硬件。
