Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
Department of Trauma Surgery, University of Zurich, Zurich, Switzerland.
Eur J Trauma Emerg Surg. 2021 Dec;47(6):1971-1978. doi: 10.1007/s00068-020-01354-9. Epub 2020 Mar 31.
Using palmar plating to treat complex intraarticular distal radius fractures is standard of care. However, fracture fragments can also be managed using a dorsal approach with arthrotomy, which is useful when treating fractures involving the dorsal joint aspect. We compared radiological and clinical outcomes after dorsal plating with or without an intraoperative arthrotomy.
31 of the 359 patients with a distal radius fracture had an AO Type 2R3 C3 fracture surgically treated using a dorsal approach (01/2015-10/2018). Fractures other than C3 were excluded from this analysis. Group 1 (n = 14) had no arthrotomy, Group 2 (n = 17) underwent intraoperative dorsal mini-arthrotomy. Clinical results were measured by range of motion (ROM), Patient-rated wrist evaluation (PRWE) and Disabilities of arm, shoulder and hand (DASH) scores. Radiological results were evaluated using the AO scoring system.
ROM, DASH and PRWE did not differ significantly between groups. Joint surface restoration was insufficient in five patients in Group 1 (p = 0.05). A trend towards better radiological results, although not statistically significant, was noted in Group 2 (p = 0.06). Plate removal was performed in 12 patients due to limited ROM (6 patients in each group). One patient (Group 2) with chronic pain and step off in the joint line underwent corrective osteotomy.
We did not detect a difference in patient outcomes using the dorsal longitudinal mini-arthrotomy; however, it may prevent incongruent joint reconstruction since all cases occurred in Group 1. In the absence of intraoperative CT scan, longitudinal mini-arthrotomy may be used to enhance visualization and achieve joint surface reconstruction.
使用掌侧钢板治疗复杂关节内桡骨远端骨折是常规治疗方法。然而，骨折碎片也可以通过背侧入路切开关节进行处理，当治疗涉及背侧关节面的骨折时，这种方法非常有用。我们比较了背侧钢板固定加或不加术中关节切开术的影像学和临床结果。
359 例桡骨远端骨折患者中，有 31 例采用背侧入路（2015 年 1 月至 2018 年 10 月）进行手术治疗，AO 分型为 2R3C3 型。本分析排除了除 C3 以外的骨折。组 1（n=14）未行关节切开术，组 2（n=17）行术中背侧小关节切开术。通过关节活动度（ROM）、患者腕关节评估（PRWE）和上肢功能障碍（DASH）评分来测量临床结果。采用 AO 评分系统评估影像学结果。
两组间 ROM、DASH 和 PRWE 无显著差异。组 1 中有 5 例关节面复位不足（p=0.05）。尽管统计学上无显著性差异，但组 2 的影像学结果有改善趋势（p=0.06）。由于 ROM 受限，12 例患者（每组 6 例）行钢板取出术。1 例（组 2）患者因慢性疼痛和关节线台阶感而行矫正性截骨术。
我们未发现背侧纵向小关节切开术对患者结果有影响，但可能会防止关节重建不一致，因为所有病例均发生在组 1。在缺乏术中 CT 扫描的情况下，纵向小关节切开术可用于增强可视化并实现关节面重建。
