自製針筒外固定於粉碎性遠端尺骨骨折之應用：案例報告和文獻探討

Management of Comminuted Distal Ulna Fracture with a Self-made Syringe External Fixator: A Case Report and Review of The Literature

背景：遠端尺骨骨折相對於遠端橈骨骨折在之前的治療及文獻都是相對被不重視，但越來越多的文獻，在一些不穩定遠端尺骨骨折，還是建議手術治療；但遠端尺 骨因為骨質較疏鬆、接近關節面、增加整體手術時間，所以在手術治療上，仍有一些困難性；在這個案例，我們使用了之前應用於粉碎性手指骨折上的自 製針筒外固定來治療這個個案。

病歷報告及手術方法：一位 27 歲男性，因車禍受傷，X 光顯示為遠端橈骨骨折及遠端尺骨粉碎性開放性骨折，陸續接受橈骨復位內固定及尺骨清創外固定手術，在尺骨外固定方面，我們使用了自製針筒型外固定裝置，自製外固定所需的 物品為骨針、空針筒、及骨水泥，將骨針置入於骨折兩端，將骨針穿過空針筒，以針筒為連接桿，再將骨水泥灌入針筒強化整體結構；目前病人於門診追 蹤，X 光顯示尺骨復位排列良好。

討論：在遠端橈骨尺骨骨折的案例上，傳統上認為大部分只要將橈骨復位後，尺骨的排列就會不會太差及有一定的穩定性，所以尺骨大部分都是採用保守治療，但 是越來越多的文章指出，保守治療可能會帶來一些合併症包括骨折未癒合及影響到前臂的旋轉等；隨著越來越多尺骨固定的方式出現，在固定尺骨的技術上 仍具有挑戰性，因為尺骨骨頭小塊及骨質相對疏鬆；文獻上針對尺骨粉碎性骨治療的記載更是不多，本篇文章提到的自製針筒型外固定裝置，相對於傳統外 固定也有一些好處，它的價格便宜、方便取得、比較不會影響術後追蹤時 X光的照射，是一個合乎經濟效益的裝置。

結論：現在越來越多醫師認為尺骨骨折，為了達到更好的預後，在適當的狀況下需要 積極的手術治療，但手術上仍具有困難性，本文提到的自製針筒型外固定，在粉碎性尺骨骨折上，是一個容易建立、取得的替代性工具。

Introduction: The significance of distal ulna fractures is often not valued, resulting in inadequate treatment in comparison to its larger counterpart, the radius. Surgical fixation of these unstable fractures presents a challenge because of poor bone quality, the subarticular location of the fracture, and additional operative time. We used a self-made syringe external fixator to treat comminuted distal ulna fracture, which had previously been used to manage a comminuted phalanx fracture.

Patient and Methods: A 27-year-old man had right distal radial peri-implant fracture with a distal ulna comminuted fracture. He received open reduction internal fixation of the distal ulna fracture with a self-made syringe external fixation. At 12 weeks follow up, a radiograph showed with fracture site was stable with partial union, and it revealed acceptable ulnar variance between the distal radius and ulna.

Discussion: Most fractures of the distal ulnar metaphysis associated with a distal radius fracture are well aligned and stable once the distal radius has been realigned and secured and do not benefit from internal fixation. However, previous studies have reported several complications about conservative treatment of distal ulna fractures including nonunion and marked restriction of forearm rotation. There are several methods of fixation including percutaneous K-wires, condylar blade plating, intrafocal pin plating, locking plate, and external fixation. A self-made syringe external fixator is a convenient and cost effective tool for fixation of distal ulna comminuted fracture.

Conclusion: The relevance of ulnar wrist fixation and wrist functional outcome is well-known by orthopedic surgeons. Therefore, ulnar wrist fixation is getting more attention. This “simple construct” self-made syringe external fixator is an alternative tool recommended for dealing with comminuted distal ulna fracture.