Mehrzad Raman, Kim David C
From the Department of Orthopedic and Reconstructive Surgery, Reliant Medical Group, Worcester, MA.
Ann Plast Surg. 2016 Dec;77(6):623-625. doi: 10.1097/SAP.0000000000000850.
Distal radius fractures are common, accounting for approximately 18% of all fractures in adults. Operative management is common, and there are numerous variants of plates used. However, data on safety and complication rates for different plates are limited.
To determine whether the rate of complications differed between two distinct types of volar plate design for distal radius fracture fixation, one using predetermined fixed angles for the locking screws or pegs and the other using a variable angle locking design for the locking screws or pegs. Our null hypothesis was that the rate of complications would be the same in each group.
A retrospective chart review was performed on patients with unstable distal radius fractures treated operatively between 2008 and 2011. Patients treated with external fixation or small fragment plates were excluded; all remaining patients underwent internal fixation with 1 of 3 plate designs: Stryker Universal Distal Radius Plate, Acumed Acu-Loc, or Trimed Volar Bearing Plate.
A total of 189 patients underwent surgical treatment for an unstable distal radius fracture with a volar plate. Fixed angle plates were used in 60 patients and polyaxial locking plates using a rotatable bearing were used in 148 patients. In the fixed angle plate group, 11 required a second operation on the affected limb for a total of 18 procedures. In 7 of 11 patients, secondary surgery was directly related to complications from the hardware (symptomatic hardware, loose hardware and tendon rupture). All 7 of these patients were in the fixed angle plate group, for a rate of hardware related complications of 12% (7/60). No hardware related complications occurred in patients in the group treated with a polyaxial locking plate (0/129). The complication rate in the fixed angle plate group is significantly different than 0, the rate observed in the polyaxial locking plate group (z score = 3.95, P < 0.001).
Our data suggest that treatment of unstable distal radius fractures with a volar bearing variable angle plate fixation is safe and effective. In our series, there was a significant reduction in the rate of hardware-related complications with the polyaxial locking plate as compared with a fixed angle plate.Therapeutic, Level III, retrospective comparative study.
桡骨远端骨折很常见，约占成人所有骨折的18%。手术治疗很普遍，使用的钢板有多种类型。然而，关于不同钢板的安全性和并发症发生率的数据有限。
确定用于桡骨远端骨折固定的两种不同类型掌侧钢板设计（一种使用锁定螺钉或栓钉的预定固定角度，另一种使用锁定螺钉或栓钉的可变角度锁定设计）的并发症发生率是否存在差异。我们的零假设是每组的并发症发生率相同。
对2008年至2011年接受手术治疗的不稳定桡骨远端骨折患者进行回顾性病历审查。排除接受外固定或小碎片钢板治疗的患者；所有其余患者采用以下3种钢板设计之一进行内固定：史赛克通用桡骨远端钢板、Acumed Acu-Loc或Trimed掌侧支撑钢板。
共有189例患者接受了使用掌侧钢板治疗不稳定桡骨远端骨折的手术。60例患者使用了固定角度钢板，148例患者使用了带可旋转支撑的多轴锁定钢板。在固定角度钢板组中，11例患者需要对患侧肢体进行二次手术，共进行了18次手术。在11例患者中的7例中，二次手术与硬件并发症直接相关（有症状的硬件、松动的硬件和肌腱断裂）。所有这7例患者均在固定角度钢板组中，硬件相关并发症发生率为12%（7/60）。多轴锁定钢板治疗组患者未发生硬件相关并发症（0/129）。固定角度钢板组的并发症发生率与多轴锁定钢板组观察到的发生率0显著不同（z值 = 3.95，P < 0.001）。
我们的数据表明，使用掌侧支撑可变角度钢板固定治疗不稳定桡骨远端骨折是安全有效的。在我们的系列研究中，与固定角度钢板相比，多轴锁定钢板的硬件相关并发症发生率显著降低。治疗性，III级，回顾性比较研究。
