Sügün T S, Karabay N, Gürbüz Y, Ozaksar K, Toros T, Kayalar M
Hand and Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, Kahramanlar-İzmir, Turkey.
J Hand Surg Eur Vol. 2011 May;36(4):320-4. doi: 10.1177/1753193410392869. Epub 2011 Jan 31.
Fixation of unstable distal radius fractures with palmar locking plates provides a stable reduction and early return of function, but complications arising from unrecognized dorsally prominent screws penetrating the extensor compartments are increasingly reported. Standard radiographs and fluoroscopy may not adequately visualize screw lengths, owing to the complex shape of the dorsum of the distal radius. We examined 46 distal radius fractures treated with palmar locking plates by ultrasound. Of the total 230 locking screws, 59 protruded from the dorsal cortical surface by 0.5 mm or more (range 0.5-6.1 mm). The first extensor compartment was violated by one screw, the second compartment by 22 screws, the third compartment by 15 screws, and the fourth compartment by 21 screws. Asymptomatic tenosynovitis was detected in four and symptomatic tenosynovitis in 14 of the 59 prominent screws. Ultrasound imaging may be useful in cases where intra-articular and/or comminuted fractures require distal plate placement and engagement of screws in the dorsal cortex.
使用掌侧锁定钢板固定不稳定的桡骨远端骨折可实现稳定复位并使功能早期恢复，但因未识别出背侧突出的螺钉穿透伸肌间隙而引发的并发症报道日益增多。由于桡骨远端背侧形状复杂，标准X线片和透视可能无法充分显示螺钉长度。我们通过超声检查了46例采用掌侧锁定钢板治疗的桡骨远端骨折。在总共230枚锁定螺钉中，59枚从背侧皮质表面突出0.5毫米或更多（范围为0.5 - 6.1毫米）。第一伸肌间隙被1枚螺钉侵犯，第二间隙被22枚螺钉侵犯，第三间隙被15枚螺钉侵犯，第四间隙被21枚螺钉侵犯。在59枚突出的螺钉中，4例检测到无症状性腱鞘炎，14例检测到有症状性腱鞘炎。在关节内和/或粉碎性骨折需要在远端放置钢板并使螺钉与背侧皮质接合的情况下，超声成像可能会有所帮助。
