弹道桡骨远端骨折：单中心治疗经验和结果

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-08-04 DOI:10.1016/j.jhsg.2025.100794

Kanad Ghosh MD , Manish Pathuri BS , Jason Strelzow MD , Jennifer Moriatis Wolf MD, PhD

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引用次数: 0

摘要

目的上肢的枪伤（GSWs）可能是毁灭性的，通常需要手术治疗。尤其是桡骨远端弹道性损伤，由于骨粉碎、神经血管损伤和周围结构损伤，对手外科医生来说是一个复杂的挑战。本研究比较了非弹道性和弹道性桡骨远端骨折（DRFs）的人口统计学、治疗和并发症。方法在这项回顾性研究中，回顾了2018年至2023年16岁以上影像学证实的DRFs患者。收集人口统计资料、手术细节和术后并发症资料。x线影像评估骨折愈合情况。除了对所有患者进行比较外，还进行了1:1匹配队列比较，控制了年龄、吸烟和骨折分类。结果265例患者中，21例因GSWs发生DRFs， 244例因其他机制持续DRFs。GSW患者明显年轻化，且以男性为主。Arbeitsgemeinschaft f骨合成碎片分类显示GSW患者关节内和关节外粉碎率较高，GSW患者远端尺桡关节不稳定和腕骨折的发生率较高。上肢外的额外损伤和神经血管症状在GSW患者中也更为常见。GSW患者更有可能接受手术，手术时间也更长。尽管延迟手术干预，但在固定方法、完全负重时间或并发症方面，两组之间没有观察到差异。在1:1匹配后，GSW队列中的男性比例仍然明显更高，腕部骨折率更高，非手部损伤率更高，GSW队列的手术时间更长。两组并发症发生率无显著差异。结论上肢GSWs由于其复杂性，在处理上存在相当大的问题。本研究比较了远端桡骨的弹道性和非弹道性损伤。虽然在表现和手术处理方面存在差异，但在并发症方面没有显著差异。研究类型/证据水平

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Ballistic Distal Radius Fractures: A Single-Center Experience in Management and Outcomes

Purpose

Gunshot wounds (GSWs) to the upper extremities can be devastating and often require surgical treatment. Ballistic injuries to the distal radius in particular present a complex challenge for hand surgeons because of concerns of bony comminution, neurovascular injury, and injury to surrounding structures. This study compares the demographics, management, and complications of nonballistic versus ballistic distal radius fractures (DRFs).

Methods

In this retrospective study, patients over the age of 16 years with radiographically confirmed DRFs were reviewed from 2018 to 2023. Demographic data, surgical details, and postoperative complication data were collected. X-ray imaging was evaluated for fracture healing. In addition to comparison of all patients, 1:1 matched cohort comparison was conducted, controlling for age, smoking, and fracture classification.

Results

Of the 265 patients, 21 had DRFs due to GSWs, and 244 sustained DRFs from other mechanisms. GSW patients were significantly younger and predominantly male. Arbeitsgemeinschaft für Osteosynthesefragen classification demonstrated higher intra- and extra-articular comminution in GSW patients, and GSW patients had higher rates of distal radioulnar joint instability and carpal fractures. Additional injuries outside the upper extremity and neurovascular symptoms were also more common in GSW patients. GSW patients were more likely to undergo surgery and had longer times to surgery. Despite the delayed surgical intervention, no differences were observed in fixation methods, time to full weight bearing, or complications between groups. After 1:1 matching, there remained a significantly higher proportion of men in the GSW cohort, a higher rate of carpal fractures, a higher rate of nonhand injuries, and a greater time to surgery in the GSW cohort. There remained no significant difference in complications.

Conclusions

Because of their complexity, GSWs to the upper extremities present considerable management issues. The present study compares ballistic to nonballistic injuries to the distal radius. Although there were differences in presentation and surgical management, there were no significant differences in complications.