Azad Ali, Intravia Jessica M, Hill J Ryan, Leland Hyuma, Vakhshori Venus, Stevanovic Milan, Ghiassi Alidad
Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California.
J Wrist Surg. 2019 Jun;8(3):234-239. doi: 10.1055/s-0039-1683434. Epub 2019 Mar 18.
Dorsal bridge plate fixation is an effective technique for stabilization of highly comminuted, complex distal radius fractures. However, it is unknown whether fixation to the second or third metacarpal is optimal. Given dorsal bridge plating spans the radiocarpal joint, it is unclear if the dorsal spanning plate affects carpal position. This study investigates differences in carpal translocation resulting from bridge plate distal fixation to either the second or third metacarpal. Ten paired cadaveric upper extremities without evidence of gross deformity or prior surgery distal to the elbow were evaluated with three-view wrist fluoroscopic images for baseline radiographic measurements. An unstable distal radius fracture model was created via a volar approach using a 1-cm osteotomy. Following fracture creation, a dorsal bridge plate was applied with random to the second metacarpal on one limb, and the third metacarpal on the contralateral limb. Laterality for distal fixation was chosen randomly. Fluoroscopic images were repeated and radial inclination, radial height, radiocarpal angle, volar tilt, ulnar variance, radiolunate angle, radioscaphoid angle, radial rotation index, and carpal translocation were measured. Radial inclination, radial height, radiocarpal angle, volar tilt, ulnar variance, radiolunate angle, and radioscaphoid angle were not statistically different before and after fixation, or when comparing the second or third metacarpal fixation. Additionally, there was no difference in Taleisnik's ulnar translocation index, Chamay's ulnar translation index, or McMurtry's carpal translation index based on which metacarpal was used for distal fixation. Dorsal bridge plate fixation of distal radius fractures restores preoperative physiologic measures of the radius, ulna, and carpus. Carpal translocation was similar when comparing distal fixation to the second or third metacarpal in distal radius fractures stabilized with a bridge plate. This is a Level V, therapeutic study.
背侧桥接钢板固定术是一种稳定高度粉碎性、复杂桡骨远端骨折的有效技术。然而，固定于第二掌骨或第三掌骨是否最佳尚不清楚。鉴于背侧桥接钢板跨越桡腕关节，尚不清楚背侧跨越钢板是否会影响腕骨位置。本研究调查了桥接钢板远端固定于第二掌骨或第三掌骨导致的腕骨移位差异。 对10对无明显畸形或肘部远端无既往手术证据的尸体上肢进行腕部正侧位透视图像评估，以进行基线影像学测量。通过掌侧入路使用1厘米截骨术创建不稳定的桡骨远端骨折模型。骨折形成后，在一侧肢体随机将一块背侧桥接钢板应用于第二掌骨，在对侧肢体应用于第三掌骨。远端固定的侧别随机选择。重复透视图像，测量桡骨倾斜度、桡骨高度、桡腕角、掌倾角、尺骨变异、桡月角、桡舟角、桡骨旋转指数和腕骨移位。 固定前后以及比较第二掌骨或第三掌骨固定时，桡骨倾斜度、桡骨高度、桡腕角、掌倾角、尺骨变异、桡月角和桡舟角无统计学差异。此外，根据用于远端固定的掌骨不同，Taleisnik尺骨移位指数、Chamay尺侧平移指数或McMurtry腕骨平移指数也无差异。 桡骨远端骨折的背侧桥接钢板固定可恢复桡骨、尺骨和腕骨的术前生理指标。在用桥接钢板固定的桡骨远端骨折中，比较远端固定于第二掌骨或第三掌骨时，腕骨移位相似。 这是一项V级治疗性研究。
