Gabl M, Arora R, Klauser A S, Schmidle Gernot
Division of Hand Surgery, Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Arch Orthop Trauma Surg. 2016 Aug;136(8):1181-8. doi: 10.1007/s00402-016-2490-0. Epub 2016 Jun 17.
The purpose of this study was to assess characteristics of radiocarpal arthrofibrosis after intra-articular distal radius fractures (DRF).
In this study 20 patients who underwent wrist arthroscopy at the time of implant removal after volar plating for intra-articular DRF were included retrospectively. The direction of fibrous tissue formation (FTF) and its rigidity were investigated. The findings were correlated to the course of intraarticular fracture lines seen in the preoperative CT, patient age and AO fracture types.
In all patients FTF spanned the radiocarpal joint. Fibrous tissue formations extended from previous fracture gaps to the scapholunate interosseous ligament and/or capsule. Four basic types of FTF (Type 1-4) and two combination types (Type 1a, 2a) were found. Fibrotic fans with dorsal capsular attachment (Type 1, 30 %) and its combination with dorsal capsule obliteration (Type 1a, 40 %) were the most common findings. Mild rigidity was present in 3 (15 %), moderate in 7 (35 %), and severe rigidity in 10 cases (50 %). Fracture lines crossing the radius extensor compartments or interfacet ridge, cartilage defects and C3 fractures showed the highest risk to develop severely rigid fibrous tissue formations. In older patients and in more comminuted fractures the number of rigid fibrous tissue formations was higher.
Fracture severity correlates with the development of rigid intra-articular FTF. In case of rigid FTF with restricted wrist motion arthroscopic debridement may be considered at the time of hardware removal.
本研究旨在评估桡骨远端关节内骨折（DRF）后桡腕关节纤维性关节强直的特征。
本研究回顾性纳入了20例因关节内DRF接受掌侧钢板固定后在取出内植物时接受腕关节镜检查的患者。研究了纤维组织形成（FTF）的方向及其硬度。研究结果与术前CT中所见的关节内骨折线走向、患者年龄及AO骨折类型相关。
所有患者的FTF均跨越桡腕关节。纤维组织从先前的骨折间隙延伸至舟月骨间韧带和/或关节囊。发现了四种基本类型的FTF（1 - 4型）和两种组合类型（1a型、2a型）。最常见的发现是伴有背侧关节囊附着的纤维化扇形结构（1型，30%）及其与背侧关节囊闭塞的组合（1a型，40%）。3例（15%）存在轻度硬度，7例（35%）为中度，10例（50%）为重度。穿过桡骨伸肌间隔或关节面嵴的骨折线、软骨缺损和C3骨折发生严重僵硬纤维组织形成的风险最高。在老年患者和骨折粉碎程度更高的情况下，僵硬纤维组织形成的数量更多。
骨折严重程度与关节内僵硬FTF的发生相关。对于伴有腕关节活动受限的僵硬FTF，在取出内植物时可考虑进行关节镜下清创。
