Miller Ashley, Lightdale-Miric Nina, Eismann Emily, Carr Preston, Little Kevin James
Department of Orthopaedic Surgery, University of Cincinnati School of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA.
J Hand Surg Am. 2018 Jan;43(1):81.e1-81.e8. doi: 10.1016/j.jhsa.2017.07.012. Epub 2017 Aug 23.
The radius bone has a slight dorsoradial bow that allows for full forearm pronosupination around the ulna. However, radial malunion can lead to reversal of the radial bow and subsequent volar instability of the distal radioulnar joint (DRUJ), predominantly in supination. This study assessed the outcomes of corrective radial osteotomy for volar DRUJ instability after radial malunion in children.
The charts of 7 children (2 boys and 5 girls) treated with corrective radial osteotomy for volar DRUJ instability after a radius fracture or deformity were reviewed. Demographic, diagnostic, treatment, and complication information was collected for each patient. Radiographs at initial injury, fracture union, diagnosis of DRUJ instability, and final follow-up were reviewed for radiographic measurements of radial deformity and subsequent correction.
Fractures included 4 distal radius, 2 proximal radius, and 1 plastic deformation of the radial shaft. Volar DRUJ instability was diagnosed an average of 2.7 years (range, 1-6 years) after fracture at an average age of 13.6 years (range, 12-17 years). Two of 7 patients had persistent symptoms despite having undergone previous soft tissue surgery for DRUJ instability. Radial osteotomy was performed on all patients (3 dorsal and 4 volar approaches), with an average sagittal plane correction of 23° ± 10° (range, 14° to 40°). Osteotomy site varied (3 proximal third, 1 middle third, and 3 distal third) based on the apex of maximal deformity. Patients were observed an average of 2.3 years (range, 1.0-5.7 years). At final follow-up, all patients had a stable DRUJ and no patient required soft tissue stabilization.
Apex volar malunion of radial fractures may result in volar instability of the DRUJ. Radial osteotomy restored the normal apex dorsal radial bow and effectively stabilized the DRUJ without the need for soft tissue repair. Osteotomy should be tailored to the specific site of radiographic deformity.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
桡骨有轻微的背桡侧弓形，可使前臂围绕尺骨进行充分的旋前和旋后。然而，桡骨畸形愈合可导致桡骨弓形反转，继而引起下尺桡关节（DRUJ）掌侧不稳定，主要发生在旋后位。本研究评估了儿童桡骨畸形愈合后针对DRUJ掌侧不稳定行桡骨截骨矫正术的疗效。
回顾了7例（2例男孩和5例女孩）因桡骨骨折或畸形后行桡骨截骨矫正术治疗DRUJ掌侧不稳定的患儿病历。收集了每位患者的人口统计学、诊断、治疗及并发症信息。对初次受伤、骨折愈合、DRUJ不稳定诊断及最终随访时的X线片进行回顾，以测量桡骨畸形及后续矫正情况。
骨折包括4例桡骨远端骨折、2例桡骨近端骨折和1例桡骨干塑性变形。平均在骨折后2.7年（范围1 - 6年）、平均年龄13.6岁（范围12 - 17岁）时诊断为DRUJ掌侧不稳定。7例患者中有2例尽管之前因DRUJ不稳定接受了软组织手术，但仍有持续症状。所有患者均行桡骨截骨术（3例采用背侧入路，4例采用掌侧入路），矢状面平均矫正23°±10°（范围14°至40°）。根据最大畸形顶点不同，截骨部位各异（3例在近端三分之一处，1例在中段三分之一处，3例在远端三分之一处）。患者平均观察2.3年（范围1.0 - 5.7年）。在最终随访时，所有患者的DRUJ均稳定，且无患者需要软组织稳定术。
桡骨骨折的掌侧畸形愈合可能导致DRUJ掌侧不稳定。桡骨截骨术恢复了正常的背桡侧弓形顶点，有效稳定了DRUJ，无需进行软组织修复。截骨术应根据X线畸形的具体部位进行调整。
研究类型/证据水平：治疗性研究V级
