Izawa Yuta, Tsuchida Yoshihiko, Futamura Kentaro, Ochi Hironori, Baba Tomonori
Department of Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, 247-8533 Kanagawa, Japan.
Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8431 Tokyo, Japan.
SICOT J. 2020;6:29. doi: 10.1051/sicotj/2020026. Epub 2020 Jul 27.
Loss of reduction after operative fixation of volarly unstable distal radius fractures with a volar lunate facet fragment (VLF) is considered problematic because it results in carpal subluxation or dislocation and subsequent impaired function. We hypothesized that the indicator of loss of reduction of the VLF after fixation is plate coverage of the bony fragment. We investigated the relationship between the plate coverage of the VLF and loss of reduction after fixation, and calculated the plate coverage that was associated with failure of fixation of the VLF.
We conducted a retrospective review. We included patients with surgically treated volarly unstable distal radius fractures with VLF with a volar locking plate who had a minimum follow-up of 6 months. A total of 33 patients (35 wrists) met criteria for inclusion into the study. The patients were divided into a displacement group and a non-displacement group. We calculated and compared longitudinal dimension and plate coverage of the VLF between the two groups to reveal the risk factors for loss of reduction.
At final follow-up, 25 fractures maintained radiographic alignment and 10 (28.6%) lost reduction. Univariate analysis between the two groups showed that plate coverage against the transverse and longitudinal dimension of the VLF was correlated with loss of reduction after operative fixation. In multivariate logistic regression analysis, only plate coverage against the longitudinal dimension of the VLF remained a significant predictor of failure. With 64.7% as the cut-off point for plate coverage against the longitudinal dimension of the VLF, the sensitivity and specificity of the prediction were 96% and 80%, respectively.
The predictor of loss of reduction after fixation of volarly unstable distal radius fractures with a VLF was plate coverage against the longitudinal dimension of the VLF.
对于伴有掌侧月骨面骨折块（VLF）的掌侧不稳定型桡骨远端骨折，手术固定后复位丢失被认为是个问题，因为它会导致腕骨半脱位或脱位，进而导致功能受损。我们假设固定后VLF复位丢失的指标是骨块的钢板覆盖情况。我们研究了VLF的钢板覆盖情况与固定后复位丢失之间的关系，并计算了与VLF固定失败相关的钢板覆盖情况。
我们进行了一项回顾性研究。纳入采用掌侧锁定钢板手术治疗的伴有VLF的掌侧不稳定型桡骨远端骨折患者，且至少随访6个月。共有33例患者（35侧腕关节）符合纳入本研究的标准。将患者分为移位组和未移位组。我们计算并比较两组之间VLF的纵向尺寸和钢板覆盖情况，以揭示复位丢失的危险因素。
在末次随访时，25例骨折维持了影像学对线，10例（28.6%）发生了复位丢失。两组之间的单因素分析表明，VLF横向和纵向尺寸的钢板覆盖情况与手术固定后复位丢失相关。在多因素逻辑回归分析中，只有VLF纵向尺寸的钢板覆盖情况仍然是固定失败的显著预测因素。以VLF纵向尺寸的钢板覆盖率64.7%为截断点，预测的敏感性和特异性分别为96%和80%。
伴有VLF的掌侧不稳定型桡骨远端骨折固定后复位丢失的预测指标是VLF纵向尺寸的钢板覆盖情况。
