Martinez-Mendez Daniel, Lizaur-Utrilla Alejandro, de Juan-Herrero Joaquin
Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain.
Faculty of Health Sciences, University of Alicante, Alicante, Spain.
Int Orthop. 2018 Sep;42(9):2243-2248. doi: 10.1007/s00264-018-3903-1. Epub 2018 Apr 7.
The objective was to assess the ability of the volar locking plate to maintain the radiographic parameters over the time in elderly patients with complex intra-articular distal radius fractures.
Prospective cohort of 66 consecutive patients with mean age of 68 (range 60-81) years and AO type C fractures treated with volar locking plate. Radiographic measurements were performed pre and post-operatively at each follow-up. Clinical assessment was made by Patient-Rated Wrist Evaluation scores, Disabilities of the Arm, Shoulder and Hand score, range of motion, and grip strength.
The mean post-operative follow-up was 31 (range, 24-47) months. The most difficult parameters to restore intra-operatively were volar tilt and radial height, while radial inclination and ulnar variance were restored in a high rate of patients. There was significant loss of reduction within four post-operative months in volar tilt (p = 0.001) and radial height (p = 0.029). Mean radiographic parameters had no changes from four months to final evaluation. At final follow-up, 50.1% of the patients had all radiographic parameters restored in comparison with the noninvolved wrist, but 83.3% had all radiographic parameters within a functional range (p = 0.001). No significant relationship between radiographic and functional outcomes was found (p = 0.474).
This study found that volar locking plate fixation for displaced intra-articular distal radius fractures in elderly patients was an effective procedure to obtain success functional outcomes. Although reduction loss in volar tilt and radial height occurred within four first months, volar plate was able to maintain fracture stabilization with radiographic parameters within functional range over the time in most patients of these elderly patients.
评估掌侧锁定钢板在老年复杂关节内桡骨远端骨折患者中随时间维持影像学参数的能力。
对66例连续患者进行前瞻性队列研究，这些患者平均年龄68岁（范围60 - 81岁），均为AO C型骨折，采用掌侧锁定钢板治疗。在每次随访时进行术前和术后的影像学测量。通过患者腕关节评估评分、上肢、肩部和手部功能障碍评分、活动范围和握力进行临床评估。
术后平均随访31个月（范围24 - 47个月）。术中最难恢复的参数是掌倾角和桡骨高度，而大部分患者的桡骨倾斜角和尺骨变异恢复良好。术后4个月内掌倾角（p = 0.001）和桡骨高度（p = 0.029）出现明显的复位丢失。从术后4个月到最终评估，平均影像学参数无变化。在最终随访时，50.1%的患者所有影像学参数与未受伤侧腕关节相比已恢复，但83.3%的患者所有影像学参数在功能范围内（p = 0.001）。未发现影像学结果与功能结果之间存在显著相关性（p = 0.474）。
本研究发现，掌侧锁定钢板固定治疗老年移位关节内桡骨远端骨折是获得成功功能结果的有效方法。虽然在最初4个月内掌倾角和桡骨高度出现复位丢失，但随着时间推移，掌侧钢板能够在大多数老年患者中维持骨折稳定，使影像学参数保持在功能范围内。
