Klinik Orthopädie und Unfallchirurgie, Luzerner Kantonsspital Luzern, Spitalstrasse I, 6000, Luzern 16 I, Switzerland.
Oper Orthop Traumatol. 2021 Feb;33(1):77-88. doi: 10.1007/s00064-020-00686-4. Epub 2020 Nov 27.
Minimally invasive temporary internal wrist arthrodesis as an alternative treatment method in complex distal radius fractures.
Complex distal radius fractures with dorsal and/or palmar comminution and little to no reconstruction possibilities, radiocarpal ligamentous injury, need for early weight bearing through the affected wrist (walking aids).
Complex hand injuries limiting the possibility to safely secure the plate at either the metacarpal or the radial shaft.
Percutaneous or open reduction and fixation of the distal radius fracture. Determine the location for the two stab incisions under fluoroscopy; one over the distal radial diaphysis and one over the second or third metacarpal. A third incision over Lister's tubercle allows transposition of the extensor pollicis longus (EPL) tendon, excision of the posterior interosseous nerve and dorsal arthrotomy. Retrograde insertion of the spanning plate. Placement of a first nonlocking screw through the glide hole into the metacarpal shaft. Under traction, a proximal screw hole is filled with a nonlocking screw into the radial diaphysis. Tightening of the cortical screws under lateral fluoroscopic view. The remaining screw holes at both the distal and proximal ends of the plate are filled with locking screws. Layered wound closure.
A removable wrist splint is worn during 2 weeks. Weight bearing through the injured wrist is immediately allowed. Removal of the spanning plate is scheduled at 3 months after radiographic evidence of fracture consolidation.
In total, twelve distal radius fractures were treated by dorsal spanning plate fixation between January 2018 and January 2019. Average age was 53.3 ± 24.5 years (range 22-95 years). Both 3.5 mm and 2.4/2.7 mm plates were used. All twelve fractures were healed after 3 months. The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 36.4 (range 8.3-70.0). There was one EPL tendon rupture, one case with extensor tendon adhesions, one periosteosynthetic fracture of the radial shaft and one complex regional pain syndrome. There was no implant failure and no infection.
微创临时腕关节内固定术作为复杂桡骨远端骨折的一种替代治疗方法。
背侧和/或掌侧粉碎性且重建可能性小的复杂桡骨远端骨折、桡腕背侧韧带损伤、需要早期通过受累腕部负重（助行器）。
复杂手部损伤，限制了在掌骨或桡骨干安全固定钢板的可能性。
经皮或切开复位固定桡骨远端骨折。透视下确定两个刺切迹的位置；一个在桡骨骨干远端，一个在第二或第三掌骨。在 Lister 结节上方作第三个切口，可使拇长展肌腱转位，切除正中神经骨间背侧支和背侧关节切开术。逆行插入跨关节钢板。通过导孔将一根非锁定螺钉逆行插入掌骨干。在牵引下，将一个近端螺钉孔用非锁定螺钉拧入骨骨干。在侧位透视下拧紧皮质螺钉。在钢板的远端和近端的剩余螺钉孔中拧入锁定螺钉。分层缝合伤口。
术后 2 周佩戴可移动腕关节夹板。受伤手腕立即允许负重。在影像学显示骨折愈合 3 个月后，计划取出跨关节钢板。
2018 年 1 月至 2019 年 1 月，共 12 例桡骨远端骨折采用背侧跨关节钢板固定治疗。平均年龄为 53.3±24.5 岁（范围 22-95 岁）。使用了 3.5mm 和 2.4/2.7mm 钢板。所有 12 例骨折均在 3 个月后愈合。平均残疾上肢、肩和手（DASH）评分为 36.4（范围 8.3-70.0）。有 1 例拇长展肌腱断裂，1 例伸肌腱粘连，1 例桡骨干骨膜合成骨折，1 例复杂性区域疼痛综合征。无植入物失败和感染。
