Farhan M F M, Wong J H K, Sreedharan S, Yong F C, Teoh L C
Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
J Orthop Surg (Hong Kong). 2015 Apr;23(1):19-23. doi: 10.1177/230949901502300105.
To review outcomes of combined volar and dorsal locked plating for AO type-C3 complex comminuted distal radial fractures.
Records of 24 patients aged 17 to 77 (mean, 53.3) years who underwent combined volar and dorsal locked plating for AO type-C3 distal radial fractures with volar and dorsal metaphyseal and intra-articular comminution were reviewed. 21 were closed fractures, and 3 were Gustilo-Anderson type-1 open fractures. Bone union, volar tilt, radial inclination, radial height, range of motion, grip strength, and any complications were assessed by a single hand surgeon.
After a mean follow-up of 17 (range, 14-25) months, the mean palmar flexion was 49º (range, 30º-80º), dorsiflexion was 52º (range, 30º-80º), supination was 86º (range, 60º-90º), pronation was 77º (range, 30º-90º), radial deviation was 16º (range, 5º-30º), and ulnar deviation was 27º (range, 10º-50º). The mean grip strength of the injured hand was 69.2% of the uninjured side. The mean time to radiological union was 3.9 (range, 2.5-6.0) months; no patient had non-union. At the time of union, the mean volar tilt was 5º (-22º-14º), radial inclination was 18.6º (8º-28º), and radial height was 8.5 mm (5.0 mm-13.6 mm). One patient had collapse of the dorsal fragment resulting in a dorsal tilt of 22º and limited (30º) forearm pronation. The severity of dorsal metaphyseal comminution had not been recognised and bone grafting was not performed. The patient also had minor complications of little finger flexor tendon irritation and carpal tunnel syndrome. She underwent implant removal and carpal tunnel release at 8 months. One patient had implant-related extensor digitorum communis irritation. Another patient had non-specific chronic wrist pain, which was resolved at one year. No patient had infection, tendon rupture, or complex regional pain syndrome. Four patients underwent implant removal, including 2 who had no implant-related problems.
Combined volar and dorsal plating enables early mobilisation and good outcome for certain complex comminuted distal radial fractures.
回顾掌侧和背侧锁定钢板联合治疗AO C3型桡骨远端复杂粉碎性骨折的疗效。
回顾性分析24例年龄在17至77岁（平均53.3岁）的患者，这些患者因AO C3型桡骨远端骨折合并掌侧和背侧干骺端及关节内粉碎而接受掌侧和背侧锁定钢板联合治疗。21例为闭合性骨折，3例为Gustilo-Anderson 1型开放性骨折。由一名手外科医生评估骨愈合情况、掌倾角、桡偏角、桡骨高度、活动范围、握力及任何并发症。
平均随访17个月（范围14至25个月）后，平均掌屈为49°（范围30°至80°），背伸为52°（范围30°至80°），旋后为86°（范围60°至90°），旋前为77°（范围30°至90°），桡偏为16°（范围5°至30°），尺偏为27°（范围10°至50°）。伤手的平均握力为健侧的69.2%。放射学愈合的平均时间为3.9个月（范围2.5至6.0个月）；无患者出现骨不连。在愈合时，平均掌倾角为5°（-22°至14°），桡偏角为18.6°（8°至28°），桡骨高度为8.5毫米（5.0毫米至13.6毫米）。1例患者出现背侧骨折块塌陷，导致背倾22°，前臂旋前受限（30°）。术前未认识到背侧干骺端粉碎的严重程度，未进行植骨。该患者还出现了小指屈肌腱刺激和腕管综合征等轻微并发症。她在8个月时接受了内固定取出和腕管松解术。1例患者出现与植入物相关的指总伸肌刺激。另1例患者有非特异性慢性腕部疼痛，1年后缓解。无患者发生感染、肌腱断裂或复杂性区域疼痛综合征。4例患者接受了内固定取出，其中2例无植入物相关问题。
掌侧和背侧钢板联合使用可使某些复杂粉碎性桡骨远端骨折早期活动并获得良好疗效。
