Gogna Paritosh, Selhi Harpal Singh, Singla Rohit, Devgan Ashish, Magu Narender Kumar, Mahindra Pankaj, Yamin Mohammad
Department of Orthopaedics and Rehabilitation, Pt. B.D. Sharma Post graduate Institute of Medical Sciences, 2/11-J Medical Enclave, PGIMS, Haryana, Rohtak 124001, India.
Department of Orthopaedics, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India.
ISRN Orthop. 2013 May 8;2013:131757. doi: 10.1155/2013/131757. eCollection 2013.
Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18-61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7-12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.
背景。桡骨远端背侧粉碎性骨折是不稳定骨折，治疗颇具挑战性。本研究的目的是评估采用掌侧锁定钢板固定桡骨远端背侧粉碎性骨折的功能和影像学结果。
患者与方法。连续33例桡骨远端背侧粉碎性骨折患者接受切开复位内固定治疗，使用AO 2.4mm（n = 19）/3.5mm（n = 14）的桡骨远端掌侧锁定钢板（瑞士辛迪斯公司，由印度辛迪斯私人有限公司销售）。其中A3型骨折7例，C2型骨折8例，C3型骨折18例。术后6周、3个月、6个月和1年对患者进行随访。根据上肢、肩部和手部功能障碍（DASH）问卷进行主观评估。通过测量握力和腕关节活动范围进行功能评估；影像学指标包括桡骨角度、桡骨长度、掌侧角度和尺骨变异。最终评估按照斋藤缺点评分系统进行。
结果。患者共23例男性和10例女性，平均年龄44.12±18.63岁（18 - 61岁）。所有病例骨折均在平均9.6周（范围7 - 12周）实现临床影像学愈合。最终平均伸展角度为58.15°±7.83°，屈曲角度为54.62°±11.23°，旋后角度为84.23°±6.02°，旋前角度为80.92°±5.54°。斋藤缺点评分系统结果显示，79%（n = 26）的患者为优，18%（n = 6）为良，3%（n = 1）为中。3例患者出现复位丢失，但在1年随访结束时，无患者出现肌腱刺激或断裂、内植物失败或骨不连。
结论。对于桡骨远端背侧粉碎性骨折，掌侧锁定钢板固定尽管复位丢失和骨折塌陷发生率较高，但仍能带来良好至优异的功能结果。
