Department of Orthopedics, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
School of Medicine, National Yang-Ming University, No.155, Sec. 2, Li-Nong Street, Pei-Tou District, Taipei City 112, Taiwan.
BMC Musculoskelet Disord. 2020 Mar 19;21(1):180. doi: 10.1186/s12891-020-03203-7.
Multiple approaches for fixation of distal radius fractures exist; nonetheless, there is no consensus on the optimal treatment for these injuries. Although using volar locking plates has become increasingly common as a surgical intervention, the usefulness of bone augmentation remains debatable. Therefore, this study aimed to evaluate the necessity of bone augmentation for distal radius fractures fixed with a volar locking plate.
This retrospective study enrolled patients with a single distal radius fracture treated with a volar locking plate between January 2014 and December 2016. Overall, 105 fractures were included and divided into two groups (non-bone augmentation: group 1, n = 88; bone augmentation: group 2, n = 17). Images were reviewed, and dorsal cortex collapse, volar tilting, and radial height and inclination were measured immediately after surgery and at the 6-month follow-up.
Both groups exhibited significant differences in dorsal collapse (p < 0.001 and p = 0.001, respectively) and radial height shortening (p < 0.001 and p = 0.039, respectively); volar tilting and radial inclination did not differ significantly. There was no difference in the degree of dorsal collapse (p = 0.715) and radial height shortening (p = 0.651) between the two groups. Of the 105 fractures, 54 were identified as comminuted type according to the AO classification (A3, C2, and C3), and similar radiographic outcomes were noted.
Volar locking plates for the treatment of distal radius fractures with or without bone augmentation do not affect the radiographic outcomes. In comminuted fractures, additional bone augmentation is unnecessary if intraoperative anatomical reduction and fixation are performed when possible.
治疗桡骨远端骨折有多种方法，但对于这些损伤的最佳治疗方法尚未达成共识。虽然掌侧锁定板作为一种手术干预手段已经越来越普遍，但骨增强的效果仍存在争议。因此，本研究旨在评估掌侧锁定板固定桡骨远端骨折时骨增强的必要性。
本回顾性研究纳入 2014 年 1 月至 2016 年 12 月期间采用掌侧锁定板治疗的单一桡骨远端骨折患者。共纳入 105 例骨折，分为两组（非骨增强组：1 组，n=88；骨增强组：2 组，n=17）。对图像进行评估，并在术后即刻和 6 个月随访时测量背侧皮质塌陷、掌倾、桡骨高度和倾斜度。
两组在背侧塌陷（p<0.001 和 p=0.001）和桡骨高度缩短（p<0.001 和 p=0.039）方面均有显著差异；掌倾和桡骨倾斜度无显著差异。两组背侧塌陷程度（p=0.715）和桡骨高度缩短程度（p=0.651）无差异。在 105 例骨折中，根据 AO 分类（A3、C2 和 C3）有 54 例为粉碎性骨折，影像学结果相似。
掌侧锁定板治疗桡骨远端骨折时，无论是否进行骨增强，对影像学结果均无影响。在粉碎性骨折中，如果术中能实现解剖复位和固定，则无需额外进行骨增强。
