Thomas Maxence, Hidalgo Diaz Juan José, Prunières Guillaume, Facca Sybille, Igeta Yuka, Liverneaux Philippe
Department of Hand Surgery, SOS Main, CCOM, University of Strasbourg, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France.
Department of Hand Surgery, SOS Main, CCOM, University of Strasbourg, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France; Department of Orthopaedic Surgery, Juntendo University Hospital, Tokyo, Japan.
Orthop Traumatol Surg Res. 2019 May;105(3):409-415. doi: 10.1016/j.otsr.2018.10.013. Epub 2019 Jan 30.
There are numerous internal fixation techniques for distal radius fracture, using pins, plates or nails. Some authors have developed minimally invasive procedures. The aim of the present study was to compare two minimally invasive internal fixation techniques for unstable extra-articular distal radius fracture in women over 50 years of age: volar plate (minimally invasive plate osteosynthesis: MIPO), and intramedullary nail.
The main study hypothesis was that the incision scar left by minimally invasive internal fixation is smaller using MIPO than an intramedullary nail. The secondary hypotheses were that the two techniques do not differ in terms of pain, functional score, strength, range of motion and radiologic indices.
The series comprised nineteen A2.2 and one A2.1 fractures in 20 female patients with a mean age of 72 years. The first 10 (group 1) received minimally invasive internal fixation of the distal radius by MIPO, and the other 10 (group 2) by intramedullary nail locked onto the distal radius epiphysis and diaphysis.
The main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail (mean, 14.3mm vs. 32.8mm). Some of the secondary hypotheses were also confirmed: there were no differences between the two techniques in terms of pain at 6 months, QuickDASH, PRWE (Patient-Reported Wrist Evaluation), range of motion or ulnar variance; two were not confirmed: pain at 6 weeks was less with intramedullary nails, and palmar slope was better with MIPO.
The main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail. In conclusion, the present findings showed that internal fixation of unstable extra-articular fracture in over 50-year-olds gave better clinical results at 6 weeks using an intramedullary nail, while MIPO required smaller incision.
III, retrospective study.
桡骨远端骨折有多种内固定技术，包括使用克氏针、钢板或髓内钉。一些作者开发了微创技术。本研究的目的是比较两种用于50岁以上女性不稳定关节外桡骨远端骨折的微创内固定技术：掌侧钢板（微创钢板接骨术：MIPO）和髓内钉。
主要研究假设是，使用MIPO进行微创内固定留下的切口瘢痕比髓内钉小。次要假设是，两种技术在疼痛、功能评分、力量、活动范围和影像学指标方面没有差异。
该系列包括20例女性患者的19例A2.2和1例A2.1骨折，平均年龄72岁。前10例（第1组）采用MIPO对桡骨远端进行微创内固定，另外10例（第2组）采用锁定在桡骨远端骨骺和骨干上的髓内钉。
主要研究假设得到证实：使用MIPO进行微创内固定留下的切口瘢痕比髓内钉小（平均，14.3mm对32.8mm）。一些次要假设也得到证实：两种技术在6个月时的疼痛、QuickDASH、PRWE（患者报告的腕关节评估）、活动范围或尺骨变异方面没有差异；两个未得到证实：髓内钉在6周时疼痛较轻，MIPO的掌倾角较好。
主要研究假设得到证实：使用MIPO进行微创内固定留下的切口瘢痕比髓内钉小。总之，本研究结果表明，50岁以上不稳定关节外骨折采用髓内钉在6周时临床效果更好，而MIPO切口更小。
III，回顾性研究。
