Thorninger Rikke, Madsen Mette Lund, Wæver Daniel, Borris Lars Carl, Rölfing Jan Hendrik Duedal
Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark.
Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark.
Injury. 2017 Jun;48(6):1104-1109. doi: 10.1016/j.injury.2017.03.008. Epub 2017 Mar 10.
Volar plating of unstable distal radius fractures (DRF) has become the favoured treatment. The complication rates vary from 3 to 36%. The purpose of the study was to estimate the complication rate of volar plating of DRF and its association with AO/OTA fracture type, surgeon experience and type of volar plate.
Retrospectively, all patients treated with volar plating of a DRF between February 2009 and June 2013 at Aarhus University Hospital, Denmark were included. AO/OTA fracture type, surgeon experience (1st year, 2nd-5th year resident or consultant), type of plate (VariAx, Acu-Loc) and complications were extracted from the electronic medical records. Complications were categorized as carpal tunnel syndrome, other sensibility issues, tendon complications including irritation and rupture, deep infections, complex regional pain syndrome and unidentified DRUJ or scapholunar problems. Reoperations including hardware removal were also charted.
576 patients with a median age of 63 years (min: 15; max: 87) were included. 78% were female and the mean observation time was 3.2 years (min: 2.0; max: 5.4). 78% (n=451) of the patients were treated with VariAx and 22% (n=125) with Acu-Loc. The overall complication rate was 14.6% (95% CI 11.8-17.7) including carpal tunnel syndrome or change in sensibility in 5.2% and tendon complications in 4.7%. Five flexor tendon ruptures and 12 extensor tendon ruptures were observed. The reoperation rate was 10.4% including 41 cases of hardware removal. A statistically significant association between AO/OTA fracture type C and complications was found. No statistically significant association between complication rate and surgeon experience and type of plate was observed.
The majority of DRF patients treated with a volar plate suffer no complications. However, the overall complication rate of 14.6% is substantial. Intra-articular fractures, e.g. AO/OTA-type 23C1-3, had significantly higher complication rates. Neither surgeon experience, nor type of volar plate was able to predict complications.
不稳定型桡骨远端骨折(DRF)的掌侧钢板固定已成为首选治疗方法。并发症发生率在3%至36%之间。本研究的目的是评估DRF掌侧钢板固定的并发症发生率及其与AO/OTA骨折类型、外科医生经验和掌侧钢板类型的关系。
回顾性纳入2009年2月至2013年6月在丹麦奥胡斯大学医院接受DRF掌侧钢板固定治疗的所有患者。从电子病历中提取AO/OTA骨折类型、外科医生经验(第一年、第二年至第五年住院医师或顾问医师)、钢板类型(VariAx、Acu-Loc)和并发症情况。并发症分为腕管综合征、其他感觉问题、肌腱并发症(包括刺激和断裂)、深部感染、复杂性区域疼痛综合征以及不明原因的下尺桡关节或舟月关节问题。还记录了包括取出内固定物在内的再次手术情况。
纳入576例患者,中位年龄63岁(最小15岁;最大87岁)。78%为女性,平均观察时间为3.2年(最小2.0年;最大5.4年)。78%(n = 451)的患者使用VariAx钢板治疗,22%(n = 125)使用Acu-Loc钢板治疗。总体并发症发生率为14.6%(95%CI 11.8 - 17.7),其中腕管综合征或感觉改变占5.2%,肌腱并发症占4.7%。观察到5例屈肌腱断裂和12例伸肌腱断裂。再次手术率为10.4%,其中41例为取出内固定物。发现AO/OTA C型骨折与并发症之间存在统计学显著关联。未观察到并发症发生率与外科医生经验及钢板类型之间存在统计学显著关联。
大多数接受掌侧钢板固定治疗的DRF患者无并发症。然而,14.6%的总体并发症发生率较高。关节内骨折,如AO/OTA 23C1 - 3型,并发症发生率显著更高。外科医生经验和掌侧钢板类型均无法预测并发症。