Lewis Sarah, Mostofi Amir, Stevanovic Milan, Ghiassi Alidad
Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA.
Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA.
J Hand Surg Am. 2015 Mar;40(3):500-4. doi: 10.1016/j.jhsa.2014.11.020. Epub 2015 Jan 24.
To determine the risk of iatrogenic damage to the extensor tendons and sensory nerves under a bridge plate along the second versus third metacarpal.
Using 6 paired (left-right) cadaver forearms-wrists and via a volar approach, we created a distal radius fracture with metaphyseal comminution. We then applied a dorsal distraction plate to either the second or third metacarpal. We next performed dorsal dissection of the hand and wrist over the zone of injury to determine the position of the plate relative to the extensor tendons and sensory nerves.
The bridge plate on the third metacarpal entrapped tendons of the first and third compartment in all 6 specimens. When the plate was applied to the second metacarpal there were no cases of tendon entrapment. There were no instances of nerve entrapment in plating to either the second or third metacarpal.
Distraction plating has been proposed for use in the second and third metacarpals for unstable comminuted distal radius fractures. We recommend formal exposure of the extensor tendons over the zone of injury when applying a distraction bridge plate to the third metacarpal.
Plating to the second metacarpal decreases the risk of entrapment of extensor tendons compared with plating to the third metacarpal.
确定沿第二掌骨与第三掌骨放置桥接钢板时医源性损伤伸肌腱和感觉神经的风险。
使用6对（左右）尸体前臂-腕部，通过掌侧入路制造伴有干骺端粉碎的桡骨远端骨折。然后在第二或第三掌骨上应用背侧撑开钢板。接下来对手部和腕部损伤区域进行背侧解剖，以确定钢板相对于伸肌腱和感觉神经的位置。
在所有6个标本中，第三掌骨上的桥接钢板均卡压第一和第三间隔的肌腱。当钢板应用于第二掌骨时，没有出现肌腱卡压的情况。在第二或第三掌骨上放置钢板均未出现神经卡压的情况。
对于不稳定的粉碎性桡骨远端骨折，已有人提出在第二和第三掌骨使用撑开钢板。我们建议在将撑开桥接钢板应用于第三掌骨时，对损伤区域的伸肌腱进行正规显露。
与在第三掌骨放置钢板相比，在第二掌骨放置钢板可降低伸肌腱卡压的风险。
