Del Piñal Francisco, Klausmeyer Melissa, Moraleda Eduardo, de Piero Guillermo H, Rúas Jaime S
Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
J Hand Surg Am. 2014 May;39(5):835-43. doi: 10.1016/j.jhsa.2014.02.013. Epub 2014 Mar 25.
In the setting of severely comminuted diaphyseal-metaphyseal fractures of the distal radius, arthroscopic reduction of the joint surface is difficult and often results in shortening and collapse. Yet, several authors have shown the benefits of arthroscopy in articular distal radius fractures. We present a method that safely allows a combination of arthroscopic reduction and rigid fixation and describe the outcomes in a small group of patients.
Four consecutive patients with severely comminuted diaphyseal-metaphyseal articular fractures of the distal radius were treated using the stable reference fragment technique. For all cases, we used an extra-long volar locking plate applied to the diaphysis of the radius. Preoperative computed tomography scanning was used to identify the largest articular fragment. This reference fragment was reduced and stabilized with locking pegs or screws to the volar plate under fluoroscopic guidance. The articular reduction continued arthroscopically, using the reference fragment as a guide. Once the articular reduction was complete, the comminuted metaphysis was addressed and secured to the plate.
All patients achieved excellent clinical and radiological results. Flexion-extension averaged 124° and pronation-supination averaged 174°. One patient showed minor signs of radiocarpal osteoarthritis on radiographs at 3 years.
By securing the reference fragment before addressing the metaphyseal comminution, a stable platform was created. Thus, intra-articular reduction was achieved while maintaining extra-articular alignment. Although the results were excellent, the number of cases was small.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
在桡骨远端严重粉碎性骨干-干骺端骨折的情况下，关节镜下复位关节面困难，且常导致短缩和塌陷。然而，一些作者已证明关节镜在桡骨远端关节内骨折中的益处。我们介绍一种能安全实现关节镜复位与坚强内固定相结合的方法，并描述一小群患者的治疗结果。
连续4例桡骨远端严重粉碎性骨干-干骺端关节内骨折患者采用稳定参考碎片技术治疗。所有病例均使用一块超长的掌侧锁定钢板固定于桡骨干。术前通过计算机断层扫描确定最大的关节碎片。在透视引导下，将该参考碎片用锁定钉或螺钉复位并固定于掌侧钢板。以该参考碎片为导向，继续通过关节镜进行关节复位。一旦关节复位完成，处理粉碎的干骺端并固定于钢板。
所有患者均获得了优异的临床和影像学结果。屈伸平均124°，旋前-旋后平均174°。1例患者在3年时X线片显示有轻微的桡腕骨关节炎迹象。
在处理干骺端粉碎之前固定参考碎片，创建了一个稳定的平台。因此，在维持关节外对线的同时实现了关节内复位。尽管结果优异，但病例数量较少。
研究类型/证据水平：治疗性IV级。
