del Piñal Francisco, Cagigal Leopoldo, García-Bernal Francisco J, Studer Alexis, Regalado Javier, Thams Carlos
Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
J Hand Surg Am. 2010 Mar;35(3):392-7. doi: 10.1016/j.jhsa.2009.12.001. Epub 2010 Feb 11.
A malunion with a step-off of 1 mm or more after an intra-articular distal radius fracture may cause pain and arthritic changes at midterm follow-up. We present our technique for treating intra-articular distal radius malunions by carrying out an osteotomy from inside the joint outward under arthroscopic guidance using the dry arthroscopy technique, with emphasis on the clinical and radiologic outcomes.
We performed surgery on 11 patients for intra-articular malunion of the distal radius 1 to 5 months after the injury. Preoperative step-offs ranged from 2 to 5 mm (average, 2.5 mm) on plain radiographs. Original fracture patterns involved 1 radial styloid fracture, 1 radiocarpal fracture-dislocation, and 9 comminuted intra-articular fractures. In 5 cases an anterior-ulnar or radial styloid fragment was repositioned. In the rest, more than 1 fragment (up to 3) was osteotomized. In 1 patient the articular osteotomy was combined with an ulnar shortening osteotomy.
Follow-up ranged from 12 to 48 months. Step-offs were reduced in most cases to 0 mm; however, localized gaps (<2 mm) and cartilage defects were commonly seen intraoperatively because the fragments did not accurately fit. According to the Gartland and Werley score, there were 4 excellent and 7 good results (mean score of 2.8). The Modified Green and O'Brien system achieved a mean score of 83, with 3 excellent, 5 good, and 3 fair results. One patient showed radiolunate narrowing on follow-up radiographs.
Arthroscopically assisted osteotomy permits direct visualization of the osteotomy site with good midterm clinical and radiologic outcomes. The technique can be used in irregularly defined fragments.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
关节内桡骨远端骨折后出现1毫米或以上的台阶样畸形愈合可能会在中期随访时导致疼痛和关节炎改变。我们介绍一种通过使用干式关节镜技术在关节镜引导下从关节内向关节外进行截骨术来治疗关节内桡骨远端畸形愈合的技术，并重点阐述其临床和放射学结果。
我们对11例受伤后1至5个月的桡骨远端关节内畸形愈合患者进行了手术。术前X线平片上台阶样畸形的范围为2至5毫米（平均2.5毫米）。原始骨折类型包括1例桡骨茎突骨折、1例桡腕关节骨折脱位和9例粉碎性关节内骨折。5例患者重新复位了尺侧或桡骨茎突前侧碎片。其余患者中，1个以上碎片（最多3个）进行了截骨术。1例患者的关节截骨术与尺骨短缩截骨术联合进行。
随访时间为12至48个月。大多数病例中台阶样畸形减少至0毫米；然而，术中常见局部间隙（<2毫米）和软骨缺损，因为碎片不能精确匹配。根据Gartland和Werley评分，结果为4例优和7例良（平均评分为2.8）。改良的Green和O'Brien系统平均评分为83分，其中3例优、5例良和3例可。1例患者随访X线片显示桡月关节间隙变窄。
关节镜辅助截骨术可直接观察截骨部位，中期临床和放射学结果良好。该技术可用于不规则形状的碎片。
研究类型/证据水平：治疗性IV级。
