Harness Neil G
Kaiser Permanente Orange County, University of California Irvine, Anaheim, California.
J Wrist Surg. 2016 Mar;5(1):9-16. doi: 10.1055/s-0035-1570739. Epub 2016 Jan 6.
Background Fractures of the distal radius with small volar ulnar marginal fracture fragments are difficult to stabilize with standard volar locking plates. The purpose of this study is to describe alternative techniques available to stabilize these injuries. Materials and Methods Five patients were identified retrospectively with unstable volar lunate facet fracture fragments treated with supplemental fixation techniques. The demographic data, pre- and postoperative radiographic parameters, and early outcomes data were analyzed. The AO classification, preoperative and final postoperative ulnar variance, articular step-off, volar tilt, radial inclination, and teardrop angle were measured. The lunate subsidence and length of the volar cortex available for fixation were measured from the initial injury films. Description of Technique Lunate facet fixation was based on the morphology of the fragment, and stabilization was achieved with headless compression screws in three patients, a tension band wire construct in one, and two cortical screws in another. Results Five patients with a mean age of 58 years (range: 41-82) were included. There were two AO C3.2 and three B3.3 fractures. Preoperative radiographic measurements including radial inclination, tilt, and ulnar variance all improved after surgery and were maintained within normal limits at 3-month follow-up. There was no change in the teardrop angle at final follow-up (70-64 degrees; p = 0.14). None of the patients had loss of fixation or volar carpal subluxation. The mean visual analog scale pain score at 3 months was 1 (range: 0-2). Conclusions The morphology of volar lunate facet fracture fragments is variable, and fixation must be customized to the particular pattern. Small fragments may preclude the use of plates and screws for fixation. These fractures can be managed successfully with tension band wire constructs and headless screws. These low-profile implants may decrease the risk of tendon irritation that might accompany distally placed plates.
背景 伴有小的掌侧尺骨边缘骨折块的桡骨远端骨折，采用标准掌侧锁定钢板难以实现稳定固定。本研究的目的是描述可用于稳定此类损伤的替代技术。材料与方法 回顾性纳入5例采用补充固定技术治疗的不稳定掌侧月骨小关节面骨折块患者。分析人口统计学数据、术前和术后影像学参数以及早期疗效数据。测量AO分型、术前和术后最终的尺骨变异、关节台阶、掌倾角、桡骨倾斜角和泪滴角。从最初的损伤X线片测量月骨塌陷情况以及可用于固定的掌侧皮质骨长度。技术描述 月骨小关节面固定基于骨折块的形态，3例患者采用无头加压螺钉实现稳定固定，1例采用张力带钢丝结构，另1例采用2枚皮质骨螺钉。结果 纳入5例患者，平均年龄58岁（范围：41 - 82岁）。有2例AO C3.2骨折和3例B3.3骨折。术后包括桡骨倾斜角、掌倾角和尺骨变异在内的术前影像学测量指标均得到改善，并在3个月随访时维持在正常范围内。末次随访时泪滴角无变化（70 - 64度；p = 0.14）。所有患者均未出现内固定失败或腕掌侧半脱位。3个月时平均视觉模拟评分疼痛评分为1分（范围：0 - 2分）。结论 掌侧月骨小关节面骨折块的形态各异，固定必须根据具体情况进行定制。小骨折块可能无法使用钢板和螺钉进行固定。这些骨折可通过张力带钢丝结构和无头螺钉成功治疗。这些外形小巧的植入物可能会降低使用置于远端的钢板时伴随的肌腱激惹风险。
