Musgrave Douglas S, Idler Richard S
Rebound Orthopedics, Southwest Washington Medical Center, Vancouver, WA 98664, USA.
J Hand Surg Am. 2005 Jul;30(4):743-9. doi: 10.1016/j.jhsa.2005.03.006.
To determine whether volar fixed-angle plate fixation with a new plate system could be used to treat dorsally unstable distal radius fractures. We hypothesized that volar fixed-angle plate fixation with or without radial styloid fixed-angle plate fixation would provide sufficient rigidity to allow early active range of motion without compromising fracture reduction. The initiation of early active motion may improve functional outcomes.
A retrospective review was conducted of one institution's initial experience using a new volar fixed-angle plate system to treat dorsally displaced intra-articular and extra-articular distal radius fractures. Thirty-two fractures in 32 patients with dorsally displaced distal radius fractures were treated with a volar fixed-angle plate with or without a radial styloid fixed-angle plate. Fractures were classified using the AO classification. Radiographic parameters on preoperative, postoperative, and final follow-up radiographs were compared. The time to initiation of active range of motion was determined. Final follow-up ranges of motion and complications were reported. Finally, comparisons were made between the 23 fractures treated with a volar plate alone and the 9 fractures treated with a volar plate and a radial styloid plate.
The average follow-up period was 13 months. Two thirds of the fractures were intra-articular. Average loss of reduction from initial postoperative to final follow-up radiographs was 0 degrees of volar tilt, 1 degrees of radial inclination, and 0 mm of radial length. Active wrist and forearm ranges of motion were initiated at an average of 11 days after surgery. The final follow-up flexion-extension and pronation-supination arcs averaged 112 degrees and 151 degrees , respectively. The 9 fractures treated with the combination of a fixed-angle volar plate with a fixed-angle radial styloid plate had greater initial displacement than did the 23 fractures treated with a volar plate alone. Otherwise, differences between the 2 groups were not significant. Only 1 radial styloid plate became symptomatic.
Volar plate fixation using a new fixed-angle plate system successfully can stabilize dorsally unstable distal radius fractures. Early active range of motion was facilitated without compromising fracture reduction.
确定使用一种新型钢板系统进行掌侧固定角度钢板固定是否可用于治疗背侧不稳定的桡骨远端骨折。我们假设，无论有无桡骨茎突固定角度钢板固定，掌侧固定角度钢板固定都能提供足够的刚性，以允许早期进行主动活动范围而不影响骨折复位。早期主动活动的开始可能会改善功能结果。
对一家机构使用新型掌侧固定角度钢板系统治疗背侧移位的关节内和关节外桡骨远端骨折的初步经验进行回顾性研究。32例背侧移位桡骨远端骨折患者的32处骨折采用带或不带桡骨茎突固定角度钢板的掌侧固定角度钢板进行治疗。骨折采用AO分类法进行分类。比较术前、术后和末次随访X线片上的影像学参数。确定开始主动活动范围的时间。报告末次随访时的活动范围和并发症。最后，对单纯使用掌侧钢板治疗的23处骨折和使用掌侧钢板及桡骨茎突钢板治疗的9处骨折进行比较。
平均随访期为13个月。三分之二的骨折为关节内骨折。从术后初始X线片到末次随访X线片，平均复位丢失为掌倾角0度、桡偏角1度、桡骨长度0毫米。术后平均11天开始进行主动腕关节和前臂活动范围。末次随访时的屈伸和旋前-旋后弧度平均分别为112度和151度。使用掌侧固定角度钢板与桡骨茎突固定角度钢板联合治疗的9处骨折比单纯使用掌侧钢板治疗的23处骨折初始移位更大。除此之外，两组之间的差异不显著。只有1块桡骨茎突钢板出现症状。
使用新型固定角度钢板系统进行掌侧钢板固定能够成功稳定背侧不稳定的桡骨远端骨折。在不影响骨折复位的情况下促进了早期主动活动范围。
