Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea.
Clin Orthop Surg. 2020 Mar;12(1):22-28. doi: 10.4055/cios.2020.12.1.22. Epub 2020 Feb 13.
We hypothesized that volar locking pate fixation using a minimum number of screws-four in the distal row and two in the shaft of the plate-will provide sufficient stability for unstable extra-articular fractures of the distal radius. We aimed to compare the biomechanical properties of different numbers and locations of screws in volar locking plate fixation and describe the clinical and radiological outcome of plate fixation using a minimum number of screws for distal radius fractures.
We divided 48 artificial radius fracture bones into four groups (group A-D) based on the number and location of screws used for fixation with volar locking plates. The artificial bone models were subjected to axial compression and volar bending load with a force of 250 N and 80 N, respectively, for 1,000 cycles at a frequency of 1 Hz. We also retrospectively reviewed 42 patients with unstable, extra-articular, distal radius fractures who were treated with volar locking plate fixation using a minimum number of screws.
Group A (seven distal screws and three proximal screws) had the highest mean stiffness: 303.7 N/mm under axial compression and 61.1 N/mm under volar bending. Compared with group A, group D (four screws in the distal part and two screws in the shaft) showed significantly lower stiffness; therefore, group D was considered inferior in terms of stability. However, in the fatigue test, neither deformation of the metal plate nor detachment or breakage of the metal screws was observed in all groups. In the clinical study, all fractures united without displacement and satisfactory clinical outcome was obtained.
In the dorsally comminuted, extra-articular, nonosteoporotic distal radius fractures, the minimum number of screws-four in the distal row and two in the shaft-in volar locking plate fixation can provide sufficient stability. Further biomechanical studies involving osteoporotic bone will be necessary to confirm the results because volar plate fixation is most commonly used in patients with osteoporosis.
我们假设使用最少数量的螺钉（远端排四颗，钢板杆部两颗）进行掌侧锁定钢板固定，对于不稳定的关节外桡骨远端骨折将提供足够的稳定性。我们旨在比较不同数量和位置的螺钉在掌侧锁定钢板固定中的生物力学特性，并描述使用最少数量的螺钉进行桡骨远端骨折钢板固定的临床和影像学结果。
我们根据掌侧锁定钢板固定时使用的螺钉数量和位置将 48 个人工桡骨骨折骨头分为四组（A-D 组）。人工骨模型分别在轴向压缩和掌屈弯曲载荷下以 250 N 和 80 N 的力进行 1000 次循环，频率为 1 Hz。我们还回顾性分析了 42 例采用最少数量螺钉的掌侧锁定钢板固定治疗的不稳定、关节外、桡骨远端骨折患者。
A 组（七颗远端螺钉和三颗近端螺钉）在轴向压缩下的平均刚度最高：303.7 N/mm，在掌屈弯曲下为 61.1 N/mm。与 A 组相比，D 组（远端部分有四颗螺钉，杆部有两颗螺钉）的刚度明显较低；因此，D 组在稳定性方面较差。然而，在疲劳试验中，所有组均未观察到金属板的变形、金属螺钉的脱落或断裂。在临床研究中，所有骨折均无移位愈合，获得了满意的临床结果。
在背侧粉碎、关节外、非骨质疏松性桡骨远端骨折中，掌侧锁定钢板固定的最少螺钉数量（远端排四颗，杆部两颗）可提供足够的稳定性。由于掌侧钢板固定最常用于骨质疏松症患者，因此需要进一步进行涉及骨质疏松性骨骼的生物力学研究来证实这些结果。
