Obata Hiroyuki, Naito Kiyohito, Sugiyama Yoichi, Nagura Nana, Goto Kenji, Kaneko Ayaka, Kawakita So, Kaneko Kazuo
Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan.
SICOT J. 2021;7:1. doi: 10.1051/sicotj/2020047. Epub 2021 Jan 8.
Although many clinical studies about distal radius fracture (DRF) accompanied by volar lunate facet fragments (VLFF) have recently been reported, none focus on the direction of displacement of distal fragments. Many previous cases with difficulty in treating DRF with VLFF were volar-displaced fractures. Thus, the postoperative risk for re-displacement is different between volar- and dorsal-displaced fractures with VLFF. The aim of this study is to compare the outcome of dorsal-displaced fractures treated using proximal volar locking plates (PVLP) between those with VLFF and those without, in order to reconsider the indications of distal volar locking plates (DVLP) and investigate the possibility of treating dorsal-displaced DRF with VLFF using PVLP.
The subjects were 122 patients with dorsal-displaced DRFs treated using PVLP (42 males and 80 females, mean age: 59.2 years old). The patients were divided into 13 patients with VLFF group and 109 patients without VLFF group, and the clinical outcomes at 12 months after surgery were compared.
No significant difference was noted on any evaluation between the groups. In addition, no postoperative re-displacement of VLFF was observed and bone union was confirmed. Furthermore, no osteoarthritic change was noted in all patients.
We confirmed that surgical treatment for dorsal-displaced DRF using PVLP is possible even in cases of DRF with VLFF. In addition, DVLP is an implant with a high complication risk; therefore, it may be necessary to reconsider the use of DVLP for dorsal-displaced DRF with VLFF treatable by PVLP.
尽管最近有许多关于伴有掌侧月骨小关节骨折块（VLFF）的桡骨远端骨折（DRF）的临床研究报道，但没有一项研究关注远端骨折块的移位方向。以前许多治疗伴有VLFF的DRF困难的病例都是掌侧移位骨折。因此，伴有VLFF的掌侧和背侧移位骨折术后再移位的风险不同。本研究的目的是比较使用掌侧近端锁定钢板（PVLP）治疗的伴有和不伴有VLFF的背侧移位骨折的疗效，以便重新考虑掌侧远端锁定钢板（DVLP）的适应证，并研究使用PVLP治疗伴有VLFF的背侧移位DRF的可能性。
研究对象为122例使用PVLP治疗的背侧移位DRF患者（男42例，女80例，平均年龄：59.2岁）。将患者分为VLFF组13例和无VLFF组109例，比较术后12个月的临床疗效。
两组在任何评估指标上均无显著差异。此外，未观察到VLFF术后再移位，且确认骨折愈合。此外，所有患者均未发现骨关节炎改变。
我们证实，即使是伴有VLFF的DRF病例，使用PVLP手术治疗背侧移位DRF也是可行的。此外，DVLP是一种并发症风险较高的植入物；因此，对于可通过PVLP治疗的伴有VLFF的背侧移位DRF，可能有必要重新考虑DVLP的使用。
