Department of Orthopaedics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Injury. 2011 Apr;42(4):393-6. doi: 10.1016/j.injury.2010.10.011. Epub 2010 Dec 3.
Distal radial fractures are common. Modern trends favour operative treatment in many instances, providing stable fixation and early functional recovery. Recent biomechanical evidence suggests that volar locking plates (VLPs) enable adequate stability for dorsally displaced fractures, both in dorsally intact (DI) and in dorsally comminuted (DC) fractures. The aim of the study was to compare the clinical outcome of these two fracture groups treated with a VLP.
Retrospective case-control analysis of 91 distal radial fractures treated surgically using VLP by a single surgeon between the years 2006 and 2008 was carried out. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthes/Orthopaedic Trauma Association (AO/OTA) classification. Based on initial pre-reduction X-rays and computed tomography (CT) scans, fractures were classified into two groups of DI and DC fractures. The patients were re-evaluated at 2 and 6 weeks, 3 and 6 months and 1 year.
Forty-one fractures (45%) were dorsally comminuted. Patients in the DC group were significantly older (mean 59 vs. 46 years, p<0.01) and included more female patients, as well as significantly more C3 type fractures than the DI group (p<0.04). The mean Disabilities of the Arm, Shoulder and Hand (DASH) score at 1 year postoperatively was 6.3±2.3 for the DC group, as compared with 6.6±2.02 for the DI group (p=0.64). Average time to return to work was longer in the DC group (81.2 vs. 63.6 days, p=0.05). Range of motion, volar tilt, and radial inclination were within clinically acceptable values and did not differ significantly among the two groups.
VLP fixation of DC distal radial fractures results in the maintenance of reduction and comparable functional and radiographical outcome with respect to DI fractures.
桡骨远端骨折较为常见。在许多情况下，现代趋势倾向于手术治疗，以提供稳定的固定和早期功能恢复。最近的生物力学证据表明，掌侧锁定钢板（VLP）能够为背侧移位骨折提供足够的稳定性，无论是在背侧完整（DI）还是背侧粉碎（DC）骨折中。本研究的目的是比较使用 VLP 治疗这两种骨折类型的临床结果。
对 2006 年至 2008 年间由一位外科医生使用 VLP 手术治疗的 91 例桡骨远端骨折进行回顾性病例对照分析。骨折根据 Arbeitsgemeinschaft für Osteosynthes/Orthopaedic Trauma Association（AO/OTA）分类进行分类。根据初始复位前 X 线和计算机断层扫描（CT）扫描，骨折分为 DI 和 DC 两组。患者在 2 周、6 周、3 个月和 1 年时进行重新评估。
41 例（45%）骨折为背侧粉碎性骨折。DC 组患者年龄明显较大（平均 59 岁比 46 岁，p<0.01），女性患者更多，C3 型骨折也明显多于 DI 组（p<0.04）。DC 组患者术后 1 年的手臂、肩部和手残疾（DASH）评分平均为 6.3±2.3，而 DI 组为 6.6±2.02（p=0.64）。DC 组患者重返工作岗位的平均时间较长（81.2 天比 63.6 天，p=0.05）。两组患者的活动范围、掌倾角和桡骨倾斜度均在临床可接受范围内，且无显著差异。
VLP 固定 DC 型桡骨远端骨折可维持复位，且与 DI 型骨折相比，在功能和影像学结果方面无显著差异。
