种植体周围桡骨远端骨折固定后的手术结果：病例系列

Surgical Outcomes Following Fixation of Peri-Implant Distal Radius Fractures: A Case Series.

作者信息

Kistler Justin M, Lutsky Kevin F, Matzon Jonas L

机构信息

Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.

出版信息

J Hand Surg Am. 2022 Feb;47(2):192.e1-192.e6. doi: 10.1016/j.jhsa.2021.04.016. Epub 2021 Jun 10.

DOI:10.1016/j.jhsa.2021.04.016

PMID:34119367

Abstract

PURPOSE

The purpose of this study was to evaluate surgical outcomes following fixation of peri-implant distal radius fractures.

METHODS

A retrospective chart review was conducted of peri-implant distal radius fractures treated surgically at a large academic practice over 18 years. Patients were included if they had previously undergone open reduction and internal fixation of a distal radius fracture; subsequently sustained a fracture at, or adjacent to, the existing hardware; and then undergone revision fixation with the removal of hardware. Fractures were categorized into 3 groups: type A (distal to the implant), type B (at the level of the implant), and type C (proximal to the implant). Outcomes, including range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, and radiographic alignment, were recorded at the latest follow-up visit.

RESULTS

Twelve peri-implant distal radius fractures that had undergone revision surgical fixation were identified. At the time of injury, the average patient age was 63 years. Ten occurred around a volar plate, 1 occurred around an intramedullary device, and 1 occurred around a dorsal plate. One fracture occurred proximal to previous hardware (type C), 9 fractures occurred at the level of previous hardware (type B), and 2 fractures occurred distal to previous hardware (type A). The median time from initial fixation to peri-implant fracture was 2.7 years. At a mean follow-up of 6 months after the removal of the hardware and revision fixation, radiographic alignment was within acceptable parameters for all injuries. At the final follow-up, the average wrist motion for flexion, extension, supination, and pronation were 66°, 66°, 83°, and 86°, respectively. The average DASH score was 6.7. Three patients experienced complications.

CONCLUSIONS

Although peri-implant fractures are infrequent complications following distal radius fracture internal fixation, outcomes of surgically treated peri-implant distal radius fractures are satisfactory with respect to radiographic alignment, range of motion, and function.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

摘要

目的

本研究旨在评估种植体周围桡骨远端骨折固定后的手术效果。

方法

对一家大型学术机构18年来手术治疗的种植体周围桡骨远端骨折进行回顾性病历审查。纳入标准为：既往曾接受桡骨远端骨折切开复位内固定术；随后在现有内固定物处或其附近发生骨折；然后接受取出内固定物的翻修固定术。骨折分为3组：A组（位于种植体远端）、B组（位于种植体水平）和C组（位于种植体近端）。在最近一次随访时记录结果，包括活动范围、手臂、肩部和手部功能障碍（DASH）问卷评分以及影像学对线情况。

结果

共确定12例接受翻修手术固定的种植体周围桡骨远端骨折。受伤时患者平均年龄为63岁。10例发生在掌侧钢板周围，1例发生在髓内装置周围，1例发生在背侧钢板周围。1例骨折发生在先前内固定物近端（C组），9例骨折发生在先前内固定物水平（B组），2例骨折发生在先前内固定物远端（A组）。从初次固定到种植体周围骨折的中位时间为2.7年。在取出内固定物并进行翻修固定后平均随访6个月时，所有损伤的影像学对线均在可接受参数范围内。在最终随访时，腕关节屈伸、旋前和旋后的平均活动度分别为66°、66°、83°和86°。平均DASH评分为6.7。3例患者出现并发症。