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1 대한골절학회지제 19 권, 제 4 호, 2006년 10월 Journal of the Korean Fractrure Society Vol. 19, N o. 4, October, 2006 종 설 원위요골골절의수술적치료 (Operative Treatment of Distal Radius Fracture) 박종웅 고려대학교의과대학정형외과학교실 서론 원위요골골절치료의원칙 통신저자 박종웅 Address reprint requests to Jong Woong Park, M.D. Department of Orthopedic Surgery, Korea University College of Medicine, 516, Gojan-dong, Danwon-gu, Ansan , Korea Tel Fax Tel Fax ospark@korea.ac.kr ospark@korea.ac.kr 497

$경피적 K- 강선고정술 (Percutaneous K-wire fixation) Fig. 2. Intrafocal fixation reduces the fracture fragment and prevents collapse.$

2 498 Fig. 1. Schematic drawing shows the intrafocal K-wire fixation method (Kapandji s technique). 수술적치료방법 1. 경피적 K- 강선고정술 (Percutaneous K-wire fixation) Fig. 2. Intrafocal fixation reduces the fracture fragment and prevents collapse. The additional interfragmentary fixation provides more rigid fixation.

499 2. 외고정 (External Fixation) 3. 외고정및 K-강선고정술 4. 내고정 (Internal Fixation) Fig. 3. Accurate reduction of intraarticular fragment is difficult with external fixation alone.

3 외고정 (External Fixation) 3. 외고정및 K-강선고정술 4. 내고정 (Internal Fixation) Fig. 3. Accurate reduction of intraarticular fragment is difficult with external fixation alone. K-wire augmentation can overcome this problem and provides additional stability.

$fixation and anatomical reduction of fracture$

4 500 Fig. 4. The locking plate and screw fixation enables rigid fixation and anatomical reduction of fracture fragments. Fig. 5. An example shows a fragment-specific bicolumnar fixation. 5. 내고정및외고정 6. 관절경을이용한관절내골절의정복

$3D-CT is a good diagnostic tool for the intraarticular fracture of the distal radius and is very$

5 골다공증이심한원위요골골절에서골이식및골이식대체물의사용 Fig. 6. 3D-CT is a good diagnostic tool for the intraarticular fracture of the distal radius and is very helpful for the preoperative planning of fracture management. 맺음말

6 502 8) Dunning CE, Lindsay CS, Bicknell RT, Patterson SD, Johnson JA and King GJ: Supplemental pinning improves the stability of external fixation in distal radius fractures during simulated finger and forearm motion. J Hand Surg Am, 24: , ) Earnshaw SA, Aladin A, Surendran S and Moran CG: Closed reduction of colles fractures: comparison of manual manipulation and finger-trap traction: a prospective, randomized study. J Bone Joint Surg, 84-A: , ) Fernandez DL and Geissler WB: Treatment of displaced articular fractures of the radius. J Hand Surg Am, 16: , ) Gesensway D, Putnam MD, Mente PL and Lewis JL: Design and biomechanics of a plate for the distal radius. J Hand Surg Am, 20: , ) Jakob M, Rikli DA and Regazzoni P: Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg, 82-B: , ) Jupiter JB, Fernandez DL, Toh CL, Fellman T and Ring D: Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Joint Surg, 78-A: , 참고문헌 1) Adams BD: Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am, 18: , ) Auge WK 2nd and Velazquez PA: The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy. Arthroscopy, 16: , ) Cassidy C, Jupiter JB, Cohen M, et al: Norian SRS cement compared with conventional fixation in distal radial fractures. A randomized study. J Bone Joint Surg, 85-A: , ) Cohen MS and Whitman K: Calcium phosphate bone cement - the Norian skeletal repair system in orthopedic surgery. AORN J, 65: , ) Colles A: Historical paper on the fracture of the carpal extremity of the radius (1814). Injury, 2: 48-50, ) Cooney WP and Berger RA: Treatment of complex fractures of the distal radius. Combined use of internal and external fixation and arthroscopic reduction. Hand Clin, 9: , ) Dias JJ, Wray CC, Jones JM and Gregg PJ: The value of early mobilisation in the treatment of Colles fractures. J Bone Joint Surg, 69-B: , ) Jupiter JB, Ring D and Weitzel PP: Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg Am, 27: , ) Kapandji A: Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius (author s transl). Ann Chir, 30: , ) Knirk JL and Jupiter JB: Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg, 68-A: , ) Kofoed H: Comminuted displaced Colles fractures. Treatment with intramedullary methylmethacrylate stabilisation. Acta Orthop Scand, 54: , ) Konrath GA and Bahler S: Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system. J Orthop Trauma, 16: , ) Lafontaine M, Hardy D and Delince P: Stability assessment of distal radius fractures. Injury, 20: , ) Lindau T, Arner M and Hagberg L: Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg Br, 22: , ) Lipton HA and Wollstein R: Operative treatment of intra-

7 503 articular distal radial fractures. Clin Orthop, 327: , ) McQueen MM: Redisplaced unstable fractures of the distal radius. A randomised, prospective study of bridging versus non-bridging external fixation. J Bone Joint Surg, 80-B: , ) Melone CP Jr: Open treatment for displaced articular fractures of the distal radius. Clin Orthop, 202: , ) Mjoberg B, Pettersson H, Rosenqvist R and Rydholm A: Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand, 55: , ) Moroni A, Faldini C, Marchetti S, Manca M, Consoli V and Giannini S: Improvement of the bone-pin interface strength in osteoporotic bone with use of hydroxyapatite-coated tapered external-fixation pins. A prospective, randomized clinical study of wrist fractures. J Bone Joint Surg, 83-A: , ) Orbay JL and Fernandez DL: Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am, 27: , ) Peine R, Rikli DA, Hoffmann R, Duda G and Regazzoni P: Comparison of three different plating techniques for the dorsum of the distal radius: a biomechanical study. J Hand Surg Am, 25: 29-33, ) Pogue DJ, Viegas SF, Patterson RM, et al: Effects of distal radius fracture malunion on wrist joint mechanics. J Hand Surg Am, 15: , ) Putnam MD, Meyer NJ, Nelson EW, Gesensway D and Lewis JL: Distal radial metaphyseal forces in an extrinsic grip model: implications for postfracture rehabilitation. J Hand Surg Am, 25: , ) Ring D, Jupiter JB, Brennwald J, Buchler U and Hastings H 2nd: Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg Am, 22: , ) Rozental TD, Beredjiklian PK and Bozentka DJ: Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg, 85-A: , ) Schmalholz A: Bone cement for redislocated Colles fracture. A prospective comparison with closed treatment. Acta Orthop Scand, 60: , ) Seitz WH Jr, Froimson AI, Leb R and Shapiro JD: Augmented external fixation of unstable distal radius fractures. J Hand Surg Am, 16: , ) Shiota E, Matsuzaki A, Arinaga M, Izaki T and Kozaki N: Conehead wedging screw for distal radius fractures in elderly patients. Clin Orthop, 407: , ) Short WH, Palmer AK, Werner FW and Murphy DJ: A biomechanical study of distal radial fractures. J Hand Surg [Am], 12: , ) Swigart CR and Wolfe SW: Limited incision open techniques for distal radius fracture management. Orthop Clin North Am, 32: , ) Trumble TE, Schmitt SR and Vedder NB: Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am, 19: , ) Trumble TE, Wagner W, Hanel DP, Vedder NB and Gilbert M: Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation. J Hand Surg Am, 23: , ) Wolfe SW, Austin G, Lorenze M, Swigart CR and Panjabi MM: A biomechanical comparison of different wrist external fixators with and without K-wire augmentation. J Hand Surg Am, 24: , ) Yetkinler DN, Ladd AL, Poser RD, Constantz BR and Carter D: Biomechanical evaluation of fixation of intraarticular fractures of the distal part of the radius in cadavera: Kirschner wires compared with calcium-phosphate bone cement. J Bone Joint Surg, 81-A: , 1999.

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