Kwak Jae-Man, Jung Gu-Hee
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Department of orthopaedic surgery, Gyeongsang national university, college of medicine and Gyeongsang national university Changwon hospital, 555 Samjungja-Dong, Changwon-si, 642-160, Republic of Korea.
BMC Musculoskelet Disord. 2018 Apr 14;19(1):117. doi: 10.1186/s12891-018-2046-2.
Volar locking plating through the flexor carpi radialis is a well-established technique for treating unstable distal radial fractures, with few reported complications. In certain circumstances, including metaphyseal comminuted fractures, bridge plating through a pronator quadratus (PQ)-sparing approach may be required to preserve the soft tissue envelope. This study describes our prospective experience with bridge plating through indirect reduction.
Thirty-three wrists (four 23A2, six 23A3, 15 23C1, and eight 23C2) underwent bridge plating through a PQ-sparing approach with indirect reduction from June 2006 to December 2010. Mean patient age was 56.8 years (range, 25-83 years), and the mean follow-up period was 47.5 months (range, 36-84 months). Changes in radiologic parameters (volar tilt, radial inclination, radial length, and ulnar variance) were analyzed, and functional results at final follow-up were evaluated by measuring the Modified Mayo Wrist Score (MMWS) and Modified Gartland-Werley Score (MGWS).
All wrists achieved bone healing without significant complications after a single operation. At final follow-up, radial length was restored from an average of 3.7 mm to 11.0 mm, as were radial inclination, from 16.4° to 22.5°, and volar tilt, from - 9.1° to 5.5°. However, radial length was overcorrected in three wrists, and two experienced residual dorsal tilt. Excellent and good results on the MGWS were achieved in 30 wrists (90.9%). The average MMWS outcome was 92.6 (range, 75-100).
Our experience with bridge plating was similar to that previously reported in the earlier publications. Compared with the conventional technique, bridge plating through a PQ-sparing approach may help in managing metaphyseal comminuted fractures of both cortices with a reduced radio-ulnar index.
经桡侧腕屈肌入路的掌侧锁定钢板内固定术是治疗不稳定桡骨远端骨折的成熟技术，并发症报道较少。在某些情况下，包括干骺端粉碎性骨折，可能需要采用保留旋前方肌（PQ）的入路进行桥接钢板内固定术以保护软组织包膜。本研究描述了我们采用间接复位桥接钢板内固定术的前瞻性经验。
2006年6月至2010年12月，33例腕部骨折（4例23A2型、6例23A3型、15例23C1型和8例23C2型）采用保留PQ的入路并间接复位进行桥接钢板内固定术。患者平均年龄56.8岁（范围25 - 83岁），平均随访时间47.5个月（范围36 - 84个月）。分析影像学参数（掌倾角、桡偏角、桡骨长度和尺骨变异）的变化，并通过测量改良梅奥腕关节评分（MMWS）和改良加特兰-韦利评分（MGWS）评估末次随访时的功能结果。
所有腕部骨折经单次手术均实现骨愈合，无明显并发症。末次随访时，桡骨长度从平均3.7mm恢复至11.0mm，桡偏角从16.4°恢复至22.5°，掌倾角从 - 9.1°恢复至5.5°。然而，3例腕部桡骨长度矫正过度，2例残留背侧倾斜。30例腕部（90.9%）在MGWS上获得优良结果。MMWS平均结果为92.6（范围75 - 100）。
我们采用桥接钢板内固定术的经验与早期文献报道相似。与传统技术相比，采用保留PQ的入路进行桥接钢板内固定术可能有助于处理双侧皮质干骺端粉碎性骨折并降低桡尺指数。
