Goto Akira, Murase Tsuyoshi, Oka Kunihiro, Yoshikawa Hideki
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
Hand Surg. 2011;16(1):29-37. doi: 10.1142/S0218810411005023.
Treatment of distal radius fractures with a volar fixed angle plate achieves sufficient stabilisation and permits early physical exercise. However, secondary displacement after surgery sometimes occurs in elderly patients with a metaphyseal comminution and/or cases in which the subchondral support pegs were not placed immediately below the subchondral zone. We treated elderly patients suffering from distal radius fractures with metaphyseal comminution, using both volar fixed angle plate with or without augmentation with a hydroxyapatite bone graft substitute to investigate the benefit of augmentation for maintaining a fracture reduction. We evaluated the differences among radiographic parameters including palmar tilt, radial inclination, and ulnar variance on immediate postoperative and final follow-up radiographs to analyse the maintenance of the initial reduction. There were no significant differences between the two groups in terms of palmar tilt (P = 0.80) and radial inclination (P = 0.17); however, ulnar variance increased significantly in the group treated with a volar fixed angle plate without augmentation (P < 0.05). It might be useful to use a combination technique of a locking plate system and the hydroxyapatite bone graft substitute as augmentation to treat distal radius comminuted fractures in elderly patients.
使用掌侧固定角度钢板治疗桡骨远端骨折可实现充分的稳定，并允许早期进行体育锻炼。然而，在患有干骺端粉碎性骨折的老年患者和/或软骨下支撑钉未直接置于软骨下区域的病例中，术后有时会发生二次移位。我们使用掌侧固定角度钢板（有或无羟基磷灰石骨移植替代物增强）治疗患有桡骨远端骨折并伴有干骺端粉碎性骨折的老年患者，以研究增强对于维持骨折复位的益处。我们评估了术后即刻和最终随访X线片上包括掌倾角、桡骨倾斜度和尺骨变异等影像学参数之间的差异，以分析初始复位的维持情况。两组在掌倾角（P = 0.80）和桡骨倾斜度（P = 0.17）方面无显著差异；然而，未使用增强材料的掌侧固定角度钢板治疗组的尺骨变异显著增加（P < 0.05）。对于治疗老年患者的桡骨远端粉碎性骨折，使用锁定钢板系统和羟基磷灰石骨移植替代物作为增强的联合技术可能是有用的。
