Boydstun Seth, Nash Lisa, Rayan Ghazi M
Department of Orthopedic Surgery & Rehabilitation, University of Oklahoma College of Medicine, Oklahoma, OK, USA.
Hand Surgery Division, INTEGRIS Baptist Medical Center, Oklahoma, OK, USA.
J Hand Surg Asian Pac Vol. 2019 Dec;24(4):412-420. doi: 10.1142/S2424835519500528.
Distal radius fractures are among the most common fractures encountered in orthopedic practices. If treated operatively, most implants are retained after the fracture heals unless there is hardware failure, limitation of wrist motion, pain, infection, tendon rupture, or tenosynovitis. Complications have been reported during hardware removal, including not knowing the exact implant prior to its removal. If a patient presents for plate removal to a surgeon who did not perform the initial fracture fixation, having a preoperative visual aid can help the treating surgeon choose the right instruments for their removal. To identify many of the available distal radius fixation devices, we searched the Internet and contacted local industry representatives. We also approached industry personnel at the commercial exhibit of a national hand society meeting to provide us with implants they manufacture. The implants were placed on the volar and dorsal aspects of sawbone models of the distal radius and in one case the radial styloid, using the screws, screwdrivers and accessories in the standard implant set and then posteroanterior and lateral x-rays of the implants were obtained. We created an atlas and a list of the screwdriver(s) used for each. We obtained radiographs and photographs for 28 implants that were manufactured by 14 different companies. Two companies sent us radiographs and photographs placed on either a sawbone or cadaveric model. We found that 7 of the implants were outliers and could be identified easily on the x-rays, whereas 21 implants had similar design of shaft and distal components. To aid the orthopedic surgeon in their removal, we compiled a comprehensive list of most distal radius fixation devices on the market including plates and their corresponding screws and screwdrivers. The goal was to help the surgeon when removing the plate to identify the implant on radiographs.
桡骨远端骨折是骨科临床中最常见的骨折之一。如果采用手术治疗，骨折愈合后多数植入物会保留，除非出现内固定失败、腕关节活动受限、疼痛、感染、肌腱断裂或腱鞘炎等情况。已有报道称在取出内固定时会出现并发症，包括在取出前不清楚确切的植入物类型。如果患者因取出钢板就诊于未进行初次骨折固定的外科医生，术前的视觉辅助工具可帮助主刀医生选择合适的取出器械。为识别多种现有的桡骨远端固定装置，我们搜索了互联网并联系了当地的行业代表。我们还在一个全国性手部协会会议的商业展览上与行业人员交流，让他们提供自己生产的植入物。将植入物放置在桡骨远端的锯骨模型的掌侧和背侧，在一个案例中还放置在桡骨茎突上，使用标准植入套件中的螺钉、螺丝刀和配件，然后获取植入物的正位和侧位X线片。我们创建了一个图谱以及用于每种植入物的螺丝刀列表。我们获取了由14家不同公司生产的28种植入物的X线片和照片。有两家公司给我们发送了放置在锯骨模型或尸体模型上的X线片和照片。我们发现其中7种植入物是异类，在X线片上很容易识别，而另外21种植入物的杆部和远端部件设计相似。为帮助骨科医生取出植入物，我们编制了一份市场上大多数桡骨远端固定装置的综合清单，包括钢板及其相应的螺钉和螺丝刀。目的是在外科医生取出钢板时帮助其在X线片上识别植入物。
