Department of Trauma and Orthopedics, Faculty of Medicine, Cairo University, Cairo, Egypt.
Ahmed Maher Teaching Hospital, Cairo, Egypt.
Int Orthop. 2022 Sep;46(9):2165-2176. doi: 10.1007/s00264-022-05469-z. Epub 2022 Jun 11.
Two different locking plate designs are now being used for volar plating of the distal radius fractures based on the freedom of screw direction; the fixed-angle, and the variable-angle (polyaxial) plates. We investigated the clinical and radiographic outcomes of both designs.
We reviewed 96 patients with 113 unstable distal radius fractures that were operated on with volar locking plates. The patients' mean age was 41 years. Fixed-angle volar locking plates were utilized in 65 fractures and variable-angle volar locking plates in 48 fractures through modified Henry approach or extended carpal tunnel approach. Full clinical and radiographic evaluation was done for all patients with a mean follow-up of 14 months.
All patients had acceptable clinical and radiographic parameters. The overall functional results (Mayo score, Quick Disability of Arm, Shoulder, and Hand (Q-DASH) score, Range of motion (ROM), and grip strength) were in favor of the variable-angle plate. The radiographic parameters were better with the variable-angle group. The variable-angle group recorded less operative time but more mean image intensifier exposure time. There were two cases of flexor tendon rupture with the fixed-angle group. Fixation with the fixed-angle system needed K-wire augmentation more than the variable-angle group. There was a positive correlation between hand dominance and the final score.
Distal radius volar locking plates yield satisfactory results comparable among different designs. In our series, the variable-angle system showed slightly better function and radiographic outcomes. Supplementary K-wires were needed more frequently with the fixed-angle system.
目前有两种不同的锁定钢板设计可用于掌侧固定桡骨远端骨折，这两种设计基于螺钉方向的自由度，即固定角度和多轴（万向）钢板。我们研究了这两种设计的临床和影像学结果。
我们回顾了 96 例 113 例不稳定桡骨远端骨折患者，这些患者均采用掌侧锁定钢板进行手术。患者的平均年龄为 41 岁。通过改良 Henry 入路或延长腕管入路，使用固定角度掌侧锁定钢板治疗 65 例骨折，使用可变角度掌侧锁定钢板治疗 48 例骨折。所有患者均进行了全面的临床和影像学评估，平均随访时间为 14 个月。
所有患者均获得可接受的临床和影像学参数。整体功能结果（Mayo 评分、手臂、肩部和手部残疾快速评分（Q-DASH）、活动范围（ROM）和握力）均有利于可变角度钢板。可变角度组的影像学参数更好。可变角度组的手术时间更短，但平均图像增强器曝光时间更长。固定角度组有 2 例屈肌腱断裂。固定角度系统的固定需要比可变角度系统更多的克氏针增强。手的优势与最终评分呈正相关。
桡骨远端掌侧锁定钢板的结果令人满意，不同设计之间的结果相似。在我们的系列中，可变角度系统显示出略好的功能和影像学结果。固定角度系统更频繁地需要补充克氏针。
