Haseeb Muhammad, Muzafar Khalid, Ghani Abdul, Bhat Khurshid A, Butt M Farooq
Department of Orthopaedics, Government Medical College Jammu, Jammu, India.
J Orthop Surg (Hong Kong). 2018 May-Aug;26(2):2309499018780871. doi: 10.1177/2309499018780871.
Open reduction and internal fixation using plates is the gold standard for the treatment of displaced forearm bone fractures in adults. The ulna being subcutaneous throughout has a constant approach. However, the radius is approached from either the dorsal or the volar side. Both the dorsal and the volar approaches to the radial shaft involve meticulous dissection and preservation of important neurovascular structures. The posterior interosseus nerve is at risk in the dorsal approach and the radial artery and its branches in the volar approach. Dissection of these structures also adds to the operative time. The possibility of a third alternate approach was perceived, which could decrease the potential risks of the conventional approaches.
Sixteen patients with radial shaft fractures in the middle third were operated on using the lateral approach: 6 of them had isolated radius fracture and 10 had both-bone fractures. There were 13 males and three females with a mean age of 37.9 years. Limited contact dynamic compression plate or locking compression plate of 3.5 mm was used to fix all fractures. All patients were operated on within 36 h of injury and then followed up till union. Union was assessed using serial radiographs and functional outcome using Anderson et al.'s criteria. The final functional outcome was assessed at an average 6 months after surgery and the results compiled.
The mean operative time in isolated radius fractures was 37.5 min and that for plating of both bones was 80.7 min. Primary bone grafting of the radius was done in one case and secondary bone grafting in another patient with delayed union of the radius. Union was achieved in all cases at a mean time of 17.25 weeks. The functional outcome was excellent in 10 patients, satisfactory in 5 patients, and unsatisfactory in 1 patient.
The lateral approach is a simple approach with low operative complexity and complications. We found this approach to provide a reliably good exposure of the middle third of the radius, enabling lateral plating without complications.
使用钢板进行切开复位内固定是治疗成人前臂移位性骨折的金标准。尺骨全程位于皮下，入路恒定。然而，桡骨可从背侧或掌侧入路。桡骨干的背侧和掌侧入路均需细致解剖并保护重要的神经血管结构。背侧入路时骨间后神经有风险，掌侧入路时桡动脉及其分支有风险。对这些结构的解剖也会增加手术时间。人们意识到可能存在第三种替代入路，这可能会降低传统入路的潜在风险。
16例桡骨干中1/3骨折患者采用外侧入路进行手术：其中6例为单纯桡骨骨折，10例为双骨骨折。男性13例，女性3例，平均年龄37.9岁。所有骨折均使用3.5mm有限接触动力加压钢板或锁定加压钢板固定。所有患者均在受伤后36小时内接受手术，随后随访直至骨折愈合。通过系列X线片评估骨折愈合情况，使用安德森等人的标准评估功能结果。术后平均6个月评估最终功能结果并汇总结果。
单纯桡骨骨折的平均手术时间为37.5分钟，双骨钢板固定的手术时间为80.7分钟。1例桡骨进行了一期植骨，另1例桡骨延迟愈合患者进行了二期植骨。所有病例均在平均17.25周时实现骨折愈合。10例患者功能结果优秀，5例满意，1例不满意。
外侧入路是一种简单的入路，手术复杂性和并发症较低。我们发现该入路能够可靠地良好暴露桡骨中1/3，便于进行外侧钢板固定且无并发症。
