Distal Radius Fractures (Broken Wrist)

桡骨远端骨折（腕关节骨折）   广东省中医院骨科    许树柴   转摘并编辑广东省中医院骨科许树柴

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.

桡骨是前臂两根骨头中较长的一根骨头，其靠近腕关节末端的部位通常被称之为桡骨远端。当靠近腕关节的区域发生损伤时，往往会出现桡骨远端骨折。

Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm.

桡骨远端骨折十分常见。实际上，桡骨骨折是手臂最常见的骨折。

  Description   描述

A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however.

桡骨远端骨折通常发生在桡骨末端上大概1英寸处，导致其损伤的形式有很多种。

One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles -- hence the name "Colles" fracture.

其中最常见的桡骨远端骨折称为克雷斯骨折，其特征为骨折块向上移位。1814年，一位爱尔兰骨科医生、解剖学家亚伯拉罕 克雷斯首先报道了克雷斯骨折，因此这类型的骨折被命名为克雷斯骨折。

· Intra-articular fracture.A fracture that extends into the wrist joint. ("Articular" means "joint.")

· 关节内骨折。骨折线延伸到腕关节内。

· Extra-articular fracture.A fracture that does not extend into the joint is called an extra-articular fracture.

· 关节外骨折。骨折线没有延伸到腕关节内。

· Open fracture.When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of the risk for infection.

· 开放性骨折。当骨折块穿破皮肤时，称之为开放性骨折。这类型的骨折需要进行紧急医疗处理，防止创口发生感染。

· Comminuted fracture.When a bone is broken into more than two pieces, it is called a comminuted fracture.

· 粉碎性骨折。当骨头块超过两块以上时，可以称之为粉碎性骨折。

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight).are more difficult to treat, for example.

对骨折类型进行分类十分重要，因为有些类型的骨折相对其他类型治疗起来比较难。例如，关节内骨折，开放性骨折，粉碎性骨折以及脱位骨折（骨折两端对位、对线不良）。

Sometimes, the other bone of the forearm (the ulna) is also broken. This is called a distal ulna fracture.

有时候，前臂另外一根骨头（尺骨）也断了，通常称之为尺骨远端骨折。

    桡骨远端骨折保守治疗与手术治疗示意图，许树柴与广东省的几个创伤骨科专家在一起。

  Cause   原因

The most common cause of a distal radius fracture is a fall onto an outstretched arm.

导致桡骨远端骨折最常见的原因是摔倒时手臂伸展撑地。

Osteoporosis (a disorder in which bones become very fragile and more likely to break) can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.

骨折疏松症（一种代谢紊乱引起的骨头松脆易于骨折）的病人即使一个小摔倒也可以导致腕关节损伤。大多数超过60岁的老年患者通常是由于站立位的一个摔倒所引起的桡骨远端骨折。

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.

如果患者遭受到严重的创伤暴力，即使是健康的骨骼也会发生腕关节损伤。例如，一起车祸或者从自行车上摔下来可以产生足够大的暴力损伤腕关节。

Good bone health remains an important prevention option. Wrist guards may help to prevent some fractures, but they will not prevent them all.

健康的骨骼需要一些预防措施来维持。护腕可以保护腕关节，预防一些骨折的发生，但并不能避免全部。

 Symptoms   症状

A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. In many cases, the wrist hangs in an odd or bent way (deformity).

腕关节骨折通常会导致疼痛，压痛，血瘀以及肿胀。在大多数情况下，腕关节骨折后保持奇怪的或者屈曲的姿势（畸形）。

 Doctor Examination   医生检查

If the injury is not very painful and the wrist is not deformed, it may be possible to wait until the next day to see a doctor. The wrist may be protected with a splint. An ice pack can be applied to the wrist and the wrist can be elevated until a doctor is able to examine it.

如果受伤部位不是特别的疼痛，并且腕关节不变形，可以等到隔天去门诊看医生。医生可能会使用夹板对受伤部位进行保护。而在医生进行检查前患者可以用冰包在腕关节部位进行敷贴，也可以抬高腕关节以便于消肿。

If the injury is very painful, if the wrist is deformed or numb, or the fingers are not pink, it is necessary to go to the emergency room.

如果受伤部位十分疼痛，腕关节变形或者感觉麻木，手指颜色苍白，此时应立即前往急诊室就诊。

To confirm the diagnosis, the doctor will order x-rays of the wrist. X-rays are the most common and widely available diagnostic imaging technique. X-rays can show if the bone is broken and whether there is displacement (a gap between broken bones). They can also show how many pieces of broken bone there are.

为了确诊，医生将会建议患者拍腕关节X片。X片是最常见的、应用十分广泛的影像诊断技术，它可以显示骨头是否骨折以及是否移位（骨折端的间隙），同时可以显示里面有多少骨折块。

Treatment  治疗

Treatment of broken bones follows one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed.

骨折治疗遵循以下基本原则：必须对移位的骨折块进行复位，在骨折端愈合之前防止其移位。

There are many treatment options for a distal radius fracture. The choice depends on many factors, such as the nature of the fracture, your age and activity level, and the surgeon's personal preferences.

桡骨远端骨折有很多治疗方法。其治疗的选择主要根据以下几种因素：如骨折的类型，患者的年龄以及活动水平，还有骨科医生的个人偏好。

Nonsurgical Treatment  非手术治疗

If the broken bone is in a good position, a plaster cast may be applied until the bone heals.

如果骨折部位保持稳定，没有发生移位，医生将在骨折部位打上石膏进行制动，直到骨折端愈合。

If the position (alignment) of your bone is out of place and likely to limit the future use of your arm, it may be necessary to re-align the broken bone fragments. "Reduction" is the technical term for this process in which the doctor moves the broken pieces into place. When a bone is straightened without having to open the skin (incision), it is called a closed reduction.

如果骨折端发生了移位，很有可能会限制患肢的活动，那么必须对骨折块进行复位。通常医生会移动骨折块，将其恢复到原来的位置，而这个过程所采用的技术我们称之为复位。在这过程中如果没有打开皮肤进行复位，我们又称之为闭合复位。

After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down. The cast is changed 2 or 3 weeks later as the swelling goes down more, causing the cast to loosen.

当骨折端对位、对线良好后，将对患肢打上石膏或是进行夹板固定。使用夹板技术在前几天的时间里可以允许患肢存在一定程度的肿胀。而石膏固定技术通常在患肢消肿后几天或者一个星期才选择使用。石膏固定后2-3周后，由于患肢逐渐消肿，将会导致石膏松动。

Depending on the nature of the fracture, your doctor may closely monitor the healing by taking regular x-rays. . If the fracture was reduced or thought to be unstable, x-rays may be taken at weekly intervals for 3 weeks and then at 6 weeks. X-rays may be taken less often if the fracture was not reduced and thought to be stable.

根据骨折的类型，医生将会建议患者定期拍X片以便于密切观察骨折端的愈合情况。如果骨折端不够稳定，愈合时间缓慢，患者需每隔3周拍一次X片。如果骨折端稳定，愈合时间没有发生延迟，那么患者可以隔更长的时间拍一次X片。

The cast is removed about 6 weeks after the fracture happened. At that point, physical therapy is often started to help improve the motion and function of the injured wrist.

石膏拆除时间为骨折发生6周后，拆除掉石膏后将进入下一个恢复阶段，此时物理治疗师开始帮助患者逐渐改善腕关节的活动功能。

Surgical Treatment   手术治疗

Sometimes, the position of the bone is so much out of place that it cannot be corrected or kept corrected in a cast. This has the potential of interfering with the future functioning of your arm. In this case, surgery may be required.

有时候，骨折端发生明显的移位，使用石膏固定很难矫正过来，而且很有可能会影响到日后手臂的活动功能，此时骨科医生将会建议进行手术治疗。

   Procedure. Surgery typically involves making an incision to directly access the broken bones to improve alignment (open reduction).

 步骤。手术过程经常会先切开一个口，让医生能够直接触及骨折部位，然后对其进行复位（开放复位）。

Depending on the fracture, there are a number of options for holding the bone in the correct position while it heals:

根据骨折类型，可以选择合适的手术方法使之正确复位以及愈合。

· Cast

· 石膏固定

· Metal pins (usually stainless steel or titanium)

· 金属钉固定（通常为不锈钢或者是金属钛）

· Plate and screws

· 钢板螺钉固定

· External fixator (a stabilizing frame outside the body that holds the bones in the proper position so they can heal)

· 外固定支架（固定在患肢部位外边的一个稳定支架，维持骨折端良好对位，可以使之愈合）

· Any combination of these techniques

· 综合使用以上各种技术

Open fractures. Surgery is required as soon as possible (within 8 hours after injury) in all open fractures. The exposed soft tissue and bone must be thoroughly cleaned (debrided) and antibiotics may be given to prevent infection. Either external or internal fixation methods will be used to hold the bones in place. If the soft tissues around the fracture are badly damaged, your doctor may apply a temporary external fixator. Internal fixation with plates or screws may be utilized at a second procedure several days later.

开放性骨折。开放性骨折的患者需要进行手术治疗，其治疗时间越快越好（在骨折后8小时内）。首先必须对暴露的软组织以及骨头进行清创，并给予抗生素预防感染。然后可以选择外固定或者内固定的手术方法对骨折端进行固定。如果骨折部位周围的软组织受损严重，医生将会使用外固定支架临时固定骨折端。几天后将进行第二个步骤，医生使用钢板或者螺钉替换外固定支架对骨折部位进行内固定。

Recovery   康复

Because the kinds of distal radius fractures are so varied and the treatment options are so broad, recovery is different for each individual. Talk to your doctor for specific information about your recovery program and return to daily activities.

由于桡骨远端骨折有各种各样的类型，其治疗方法也有好几种，对于不同类型的骨折以及治疗方法，其康复过程也不尽相同。你应和你的主刀医生商量，让他设计一个适合你的康复疗程，以利于你重返日常活动。

Pain Management   缓解疼痛

Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed to relieve pain.

大多数骨折疼痛会持续几天至两三周。许多患者发现采取冰敷，抬高患肢（抬高他们的手臂，使之高过于心脏），服用止痛的非处方药物可以帮助他们缓解疼痛。

Your doctor may recommend combining ibuprofen and acetaminophen to relieve pain and inflammation. The combination of both medications is much more effective than either one alone. If pain is severe, patients may need to take a prescription-strength medication, often a narcotic, for a few days.

你的医生会建议你服用布洛芬和对乙酰氨基酚缓解疼痛以及炎症，同时服用这两种药物可以产生更好的疗效。如果疼痛十分剧烈，患者往往需要服用处方药物，例如麻醉剂，持续服用数天。

Cast and Wound Care  石膏以及伤口护理

In some cases, original casts will be replaced because swelling has gone down so much that the cast becomes loose. The last cast is usually removed after about 6 weeks.

在某些情况下，由于患肢消肿后石膏会松动，所以需要对石膏进行更换。大约6周后可以对石膏进行拆除。

During healing, casts and splints must be kept dry. A plastic bag over the arm while showering should help. If the cast does become wet, it will not dry very easily. A hair dryer on the cool setting may be helpful.

在恢复过程中，石膏或者夹板必须保持干燥。当你洗澡时在手臂上套上一个塑料袋，可以防止其被水淋湿。如果石膏潮湿了，它将很难变干，除非在一个凉爽的环境里使用吹风机烘干。

Most surgical incisions must be kept clean and dry for 5 days or until the sutures (stitches) are removed, whichever occurs later.

大多数手术切口5天内或者在拆线前必须保持干净、干燥。

Potential Complications  潜在并发症

After surgery or casting, it is important that you achieve full motion of your fingers as soon as possible. If you are not able to fully move your fingers within 24 hours due to pain and/or swelling, contact your doctor for evaluation.

手术后或者石膏固定后，你应尽快检查手指的活动功能。如果在24小时之内由于疼痛或者肿胀你的手指不能够完全移动，应立即联系医生进行诊查。

Your doctor may loosen your cast or surgical dressing. In some cases, working with a physical or occupational therapist will be required to regain full motion.

医生将会松开石膏或者手术敷料。有时候，遵循一位物理治疗师或者职业治疗师进行康复锻炼可以帮助你恢复手指的活动功能。

Unrelenting pain may be a sign of Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) which must be treated aggressively with medication or nerve blocks.

持续的疼痛可能提示出现复合型局部疼痛综合征（反射性交感神经萎缩症），那么必须对其进行紧急处理，可以使用药物治疗，也可以对其神经进行阻断。

Rehabilitation and Return to Activity   康复以及恢复正常活动

Most people do return to all their former activities after a distal radius fracture. The nature of the injury, the kind of treatment received, and the body's response to the treatment all have an impact, so the answer is different for each individual.

大多数桡骨远端骨折患者康复后能够进行所有日常活动。其康复所需的时间受骨折类型、治疗方法以及身体对治疗的反应所影响，所以每一个患者的康复时间并不相同。

Almost all patients will have some stiffness in the wrist. This will generally lessen in the month or two after the cast is taken off or after surgery, and continue to improve for at least 2 years. If your doctor thinks it is needed, you will start physical therapy within a few days to weeks after surgery, or right after the last cast is taken off.

几乎所有的患者其腕关节会有些僵硬，但在手术后或者拆除石膏后一到两个月将会逐渐减轻，至少在两年内会持续地改善。如果医生认为这是必要的话，他会建议你在手术后数天至数周内，或者拆除石膏后开始进行物理治疗。

Most patients will be able to resume light activities, such as swimming or exercising the lower body in the gym, within 1 to 2 months after the cast is removed or within 1 to 2 months after surgery. Vigorous activities, such as skiing or football, may be resumed between 3 and 6 months after the injury.

大多数患者在拆除石膏后或者手术后1至2个月内可以进行轻微的活动，如游泳或者在健身房锻炼下身。受伤后3至6个月内可以进行剧烈的活动，如滑冰或者踢足球。

Long-Term Outcomes   远期疗效

Recovery should be expected to take at least a year.

康复至少需要一年的时间。

Some pain with vigorous activities may be expected for the first year. Some residual stiffness or ache is to be expected for 2 years or possibly permanently, especially for high-energy injuries (such as motorcycle crashes), in patients older than 50 years of age, or in patients who have some osteoarthritis. However, the stiffness is usually minor and may not affect the overall function of the arm.

第一年进行剧烈的活动如果受伤部位有些疼痛是可预料的。特别是对于高能量损伤的患者，年龄超过50岁，或者其患有骨性关节炎，在两年内或者更长的时间其受伤部位有些僵硬甚至疼痛也是可预料的。然而，僵硬程度很小并且不会影响到手臂的整体活动功能。

Finally, osteoporosis is a factor in many wrist fractures. It has been suggested that people who have a wrist fracture should be tested for bone weakness, especially if they have other risk factors for osteoporosis. Ask your doctor about osteoporosis testing.

最后，许多腕关节骨折是由于骨质疏松症所引起的。所以必须建议腕关节骨折的患者检查其骨质，特别要检查他们是否有引起骨质疏松的危险因素。可以咨询一下医生有关骨质疏松症的检查。