Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China.
Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, Republic of China.
BMC Musculoskelet Disord. 2022 Jan 3;23(1):18. doi: 10.1186/s12891-021-04984-1.
The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, marginal distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on marginal distal radius fractures. This study compared functional outcomes in patients with marginal distal radius fractures treated with two different implants.
A retrospective study was conducted, all patients who received a Synthes 2.4 mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The marginal distal radius fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa's joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded.
Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and grip strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006).
Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius's volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating marginal distal radius fractures.
掌侧锁定钢板已广泛应用于不稳定的桡骨远端骨折，以实现腕关节功能的早期恢复。已经报道，掌侧钢板突出到分水岭线与屈肌腱激惹有关，建议在此区域避免植入物突出。另一方面，边缘性桡骨远端骨折模式需要钢板穿过分水岭线，这使得在边缘性桡骨远端骨折的钢板定位上存在冲突。本研究比较了两种不同植入物治疗边缘性桡骨远端骨折患者的功能结果。
进行了一项回顾性研究，回顾了 2015 年 1 月至 2018 年 12 月期间接受施乐思 2.4mm LCP 或 Acumed Acu-Loc VLP 的所有患者。边缘性桡骨远端骨折模式为月骨窝关节线内最远端的水平骨折线，距离 10mm 以内。评估的主要结果包括患者报告的疼痛评分、活动范围和握力。次要结果包括患者对受伤手腕和手部功能的主观满意度评分。还记录了 Mayo 腕关节评分和与硬件并发症相关的二次手术的需求。
符合纳入标准的患者共 42 例。21 例患者接受施乐思 2.4mm LCP 治疗，21 例患者接受 Acumed Acu-Loc VLP 治疗。主要结果显示，Acu-Loc VLP 组术后活动范围（P=0.016）和握力（P=0.014）显著改善。Acu-Loc VLP 组的 Mayo 腕关节评分也明显更好（P=0.006）。
尽管植入物设计有所进步，但桡骨远端掌侧钢板固定后仍会发生屈肌腱激惹或断裂等并发症。我们认为，如果将 Acumed Acu-Loc VLP 正确且小心地放置在其设计位置，其设计提供了比施乐思 2.4mm LCP 更好的功能结果。这种定位在治疗边缘性桡骨远端骨折时可以获得令人满意的患者满意度。
