Mignemi Megan E, Byram Ian R, Wolfe Carmen C, Fan Kang-Hsien, Koehler Elizabeth A, Block John J, Jordanov Martin I, Watson Jeffry T, Weikert Douglas R, Lee Donald H
Department of Orthopaedics and Rehabilitation, the Division of Cancer Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
J Hand Surg Am. 2013 Jan;38(1):40-8. doi: 10.1016/j.jhsa.2012.10.007. Epub 2012 Dec 4.
To assess the ability of volar locked plating to achieve and maintain normal radiographic parameters for articular stepoff, volar tilt, radial inclination, ulnar variance, and radial height in distal radius fractures.
We performed a retrospective review of 185 distal radius fractures that underwent volar locked plating with a single plate design over a 5-year period. We reviewed radiographs and recorded measurements for volar tilt, radial inclination, ulnar variance, radial height, and articular stepoff. We used logistic regression to determine the association between return to radiographic standard norms and fracture type.
At the first and final postoperative follow-up visits, we observed articular congruence less than 2 mm in 92% of fractures at both times. Normal volar tilt (11°) was restored in 46% at the first follow-up and 48% at the final one. Radial inclination (22°) was achieved in 44% at the first follow-up and 43% at the final one, and ulnar variance (01 ± 2 mm) was achieved in 53% at the first follow-up and 53% at the final one. In addition, radial height (14 ± 1mm) was restored in 14% at the first follow-up and 12% at the final one. More complex, intra-articular fractures (AO class B and C and Frykman types 3, 4, 7, and 8) were less likely to be restored to normal radiographic parameters. However, because of the small sample size for some fracture types, it was difficult to discover significant associations between fracture type and radiographic outcome.
Volar locked plating for distal radius fractures achieved articular stepoff less than 2 mm in most fractures but only restored and maintained normal radiographic measurements for volar tilt, radial inclination, and ulnar variance in 50% of fractures. The ability of volar locked plating to restore and maintain ulnar variance and volar tilt decreased with more complex intra-articular fracture types.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
评估掌侧锁定钢板在桡骨远端骨折中实现并维持关节面台阶、掌倾角、桡骨倾斜角、尺骨变异及桡骨高度等正常影像学参数的能力。
我们对185例桡骨远端骨折进行了回顾性研究，这些骨折在5年期间采用单一钢板设计进行掌侧锁定钢板固定。我们回顾了X线片并记录了掌倾角、桡骨倾斜角、尺骨变异、桡骨高度及关节面台阶的测量值。我们使用逻辑回归分析来确定恢复到影像学标准规范与骨折类型之间的关联。
在术后首次及末次随访时，我们观察到92%的骨折在这两个时间点关节面移位均小于2mm。首次随访时46%的患者恢复了正常掌倾角（11°），末次随访时为48%。首次随访时44%的患者达到了桡骨倾斜角（22°），末次随访时为43%；首次随访时53%的患者实现了尺骨变异（01±2mm），末次随访时为53%。此外，首次随访时14%的患者恢复了桡骨高度（14±1mm），末次随访时为12%。更复杂的关节内骨折（AO分类B型和C型以及Frykman 3型、4型、7型和8型）恢复到正常影像学参数的可能性较小。然而，由于某些骨折类型的样本量较小，难以发现骨折类型与影像学结果之间的显著关联。
桡骨远端骨折采用掌侧锁定钢板固定，多数骨折的关节面台阶小于2mm，但仅50%的骨折恢复并维持了掌倾角、桡骨倾斜角及尺骨变异的正常影像学测量值。随着关节内骨折类型复杂性增加，掌侧锁定钢板恢复并维持尺骨变异及掌倾角的能力下降。
研究类型/证据水平：治疗性IV级。
