Figl Markus, Weninger Patrick, Liska Michael, Hofbauer Marcus, Leixnering Martin
Trauma Center Lorenz Boehler, Donaueschingenstrasse 13, 1200 Vienna, Austria.
Arch Orthop Trauma Surg. 2009 May;129(5):661-9. doi: 10.1007/s00402-009-0830-z. Epub 2009 Feb 19.
With an incidence of about 2-4 per 1,000 residents per year, the distal radial fracture is the most common fracture in the human skeleton. The introduction of fixed-angle plate systems for extension fractures at the radius was evaluated in a prospective study performed at our hospital after selection and acquisition of a new system. The focus of our interest was whether a secondary loss of reduction can be avoided by this plating system.
We reviewed 80 patients treated for unstable distal radius fractures using a volar fixed-angle plate. Postoperative management included immediate finger motion, early functional use of the hand, a wrist splint used for 4 weeks and physiotherapy. Standard radiographic and clinical fracture parameters after 12 months (range 12-14 months) were measured and final functional results where assessed.
Bone healing had occurred in all patients at the time of follow-up after 1 year. On X-rays taken at the time of follow-up 60 patients (75%) had no radial shortening, 20 patients (25%) had a mean radial shortening of only 1.8 mm (range 1-3 mm) compared to the contralateral side. The radial tilt was on average 22 degrees (range 14 degrees-36 degrees); the volar tilt was on average 6 degrees (range 0 degrees-18 degrees). Comparing the first postoperative X-rays with those taken at final evaluation showed no measureable loss of reduction in the volar or radial tilt. Castaing's score, which includes the radiographic results, yielded a perfect outcome in 30 cases, a good outcome in 49 cases and an adequate outcome in one case. The range of motion was on average reduced by 21% during extension/flexion, by 11% during radial/ulnar deviation and by 7% in pronation and supination compared to the contralateral side. Grip strength was 65% that of the contralateral side. The mean DASH score was 25 points.
Fixed-angle plate osteosynthesis at the distal radius signifies a significant improvement in the treatment of distal radial fractures in terms of restoration of the shape and function of the wrist. The technically simple palmar access, with a low rate of complications, allows exact anatomical reduction of the fracture. The multidirectional fixed-angle system we used provides solid support for the joint surface even in osteoporotic bone and allows simple subchondral placement of screws with sustained retention of the outcome of reduction. Secondary correction loss can be avoided by this procedure. Early mobilisation can be achieved and is recommended.
桡骨远端骨折是人类骨骼中最常见的骨折，每年发病率约为每1000名居民中有2 - 4例。在我院选用并购置一种新的固定角度钢板系统后，进行了一项前瞻性研究，对其用于桡骨伸展型骨折的情况进行评估。我们关注的焦点是该钢板系统能否避免复位后的二次丢失。
我们回顾了80例使用掌侧固定角度钢板治疗不稳定桡骨远端骨折的患者。术后处理包括立即进行手指活动、早期手部功能使用、使用腕部夹板4周以及物理治疗。测量了12个月（范围12 - 14个月）后的标准影像学和临床骨折参数，并评估最终功能结果。
随访1年后，所有患者均已发生骨愈合。随访时的X线片显示，60例患者（75%）无桡骨短缩，20例患者（25%）与对侧相比平均桡骨短缩仅1.8毫米（范围1 - 3毫米）。桡骨倾斜平均为22度（范围14度 - 36度）；掌侧倾斜平均为6度（范围0度 - 18度）。将术后第一张X线片与最终评估时的X线片比较，掌侧或桡骨倾斜未见可测量的复位丢失。包含影像学结果的卡斯坦评分显示，30例结果完美，49例结果良好，1例结果尚可。与对侧相比，伸展/屈曲时活动范围平均减少21%，桡偏/尺偏时减少11%，旋前和旋后时减少7%。握力为对侧的65%。平均DASH评分为25分。
桡骨远端固定角度钢板接骨术在恢复腕部形态和功能方面显著改善了桡骨远端骨折的治疗。技术上简单的掌侧入路，并发症发生率低，能实现骨折的精确解剖复位。我们使用的多方向固定角度系统即使在骨质疏松的骨骼中也能为关节面提供稳固支撑，并允许简单地在软骨下放置螺钉，持续保持复位效果。该手术可避免二次矫正丢失。可实现早期活动，且建议进行早期活动。
