Streubel Philipp N, Cohen Mark S
Hand and Upper Extremity Section, Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, NE.
Hand and Elbow Section, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
J Hand Surg Am. 2019 Aug;44(8):699.e1-699.e10. doi: 10.1016/j.jhsa.2018.10.007. Epub 2018 Nov 27.
The aim of this study was to assess the treatment and complications of a distinct type of partial intra-articular distal radius fracture.
Seven patients treated by the senior author between 2008 and 2013 for a partial intra-articular distal radius fracture with isolated involvement of the volar lunate facet were included. All fragments had the distinctive shape of a triangular-base pyramid (tetrahedron) extending from the metaphysis distally. All fractures were preoperatively assessed with computed tomography (CT) scans. Patients underwent surgical treatment using a standard flexor carpi radialis approach (2 patients) or a volar ulnar approach (5 patients) and were followed postoperatively for a minimum of 12 months.
Patient age ranged from 33 to 66 years. On average, fragments measured 34 ± 6 mm in length (range, 27-43 mm) and were 48% as wide as the distal radius (range, 40% to 56%) and 58% as deep as the anterior-posterior dimension of the lesser sigmoid notch (range, 33% to 83%). Loss of reduction requiring revision surgery occurred at 4 weeks in 1 patient who underwent internal fixation through the flexor carpi radialis approach. The remaining cases healed uneventfully. At the final follow-up, all, except the patient requiring revision surgery, had a painless wrist. Average total wrist motion measured 87% of the opposite side. Radiographic healing with anatomic wrist alignment was observed in all except the patient requiring revision. This patient had persistent joint subluxation. The remaining patients all achieved good or excellent functional outcomes.
Isolated tetrahedron volar lunate facet fractures of the distal radius are rare. In our experience, the use of a volar ulnar approach leads to satisfactory fixation and outcomes, yielding excellent radiographic and clinical outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
本研究旨在评估一种独特类型的桡骨远端部分关节内骨折的治疗方法及并发症。
纳入2008年至2013年间由资深作者治疗的7例桡骨远端部分关节内骨折患者，这些骨折仅累及掌侧月骨小面。所有骨折块均呈从干骺端向远端延伸的三角形基底椎体（四面体）独特形状。所有骨折术前均行计算机断层扫描（CT）检查。患者采用标准桡侧腕屈肌入路（2例）或掌侧尺侧入路（5例）接受手术治疗，术后随访至少12个月。
患者年龄在33至66岁之间。骨折块平均长度为34±6mm（范围27 - 43mm），宽度为桡骨远端的48%（范围40%至56%），深度为小乙状切迹前后径的58%（范围33%至83%）。1例通过桡侧腕屈肌入路行内固定的患者在4周时出现复位丢失，需要翻修手术。其余病例均顺利愈合。在末次随访时，除需要翻修手术的患者外，所有患者的腕关节均无痛。患侧腕关节平均总活动度为对侧的87%。除需要翻修的患者外，所有患者均实现了影像学愈合且腕关节解剖复位。该患者存在持续的关节半脱位。其余患者均获得了良好或优秀的功能结局。
桡骨远端孤立的四面体掌侧月骨小面骨折较为罕见。根据我们的经验，采用掌侧尺侧入路可实现满意的固定及预后，获得优异的影像学和临床结果。
研究类型/证据水平：治疗性研究V级
