Obata Hiroyuki, Baba Tomonori, Futamura Kentaro, Obayashi Osamu, Mogami Atsuhiko, Tsuji Hideki, Kurata Yoshiaki, Kaneko Kazuo
Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Case Rep Orthop. 2017;2017:6269081. doi: 10.1155/2017/6269081. Epub 2017 Jan 31.
Recent reports suggest the presence of a rare fracture type for which reduction and fixation cannot be achieved with volar locking plate (VLP). In particular, it is difficult to achieve reduction and fixation with volar lunate facet (VLF) fragments present on the volar ulnar aspect of the lunate facet, because of the anatomical structure and biomechanics in this region. Herein, we report two challenging cases of difficulty in fixation of the VLF fragment in distal radius fracture. For this fracture type, it is most important to identify the volar ulnar bone fragment before surgery; it may also be necessary to optimize distal placement of the VLP via a dual-window approach and to apply additional fixations, such as a small plate, anchor, and/or external fixation.
近期报告显示存在一种罕见的骨折类型，使用掌侧锁定钢板（VLP）无法实现复位和固定。特别是，由于该区域的解剖结构和生物力学特点，对于月骨小关节掌侧尺侧（VLF）存在的骨折块，很难实现复位和固定。在此，我们报告两例桡骨远端骨折中VLF骨折块固定困难的具有挑战性的病例。对于这种骨折类型，术前识别掌侧尺侧骨块最为重要；可能还需要通过双窗口方法优化VLP的远端放置，并应用额外的固定装置，如小型钢板、锚钉和/或外固定。
