Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan, ROC.
Department of Orthopedics, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
BMC Musculoskelet Disord. 2022 Jun 15;23(1):580. doi: 10.1186/s12891-022-05525-0.
Fixed-angle plate fixation can be an effective treatment for distal radius fractures (DRFs). However, patients with existing ulnar positive variance might be at risk of developing symptoms of ulnar-sided wrist pain (USWP). Ulnar shortening osteotomy (USO) is one of the main treatment options for USWP. We hypothesized that a limited radial distraction at the fracture site at the time of surgery for DRF would be functionally equivalent to an indirect USO and that if this were done in a patient with an ulnar plus morphology it could potentially decrease the risk of USWP.
This retrospective study was conducted at a single institution and all the surgeries were performed by single surgeon. A total of 136 patients (92 women and 44 men) with a mean age of 55 years were enrolled with 57 patients in the distraction group (from 2014 to 2017) and 79 patients (from 2011 to 2013) in the non-distraction group. Patients were assessed USWP. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Visual Analogue Scale (VAS) for pain, grip strength, and range of motion for the wrist.
The mean follow-up was 37.9 months (range, 28-61 months). The radiographs at postoperative 2-year follow-ups showed the mean ulnar positive variance was 1.3 mm (range, 1-2 mm) in the distraction group and 3.5 mm (range, 2-5 mm) in the non-distraction group. The average of the distraction length was 2.32 mm (range, 2-3 mm). At the 2-year follow-ups, USWP presented in 7% (four patients) in the distraction group, which was significantly less than the incidence of 28% (22 patients) in the non-distraction group. The distraction group exhibited significantly better DASH scores and grip strength and less subsequent ulnar-shortening osteotomy for ulnar-sided wrist pain.
The radial distraction procedure performed during DRFs fixation could possibly reduce the occurrence of postoperative USWP and improve the functional outcomes.
Level III, Therapeutic.
角度固定钢板固定可有效治疗桡骨远端骨折（DRF）。然而，存在尺骨阳性变异的患者可能有发生尺侧腕痛（USWP）的症状。尺骨缩短截骨术（USO）是治疗 USWP 的主要治疗方法之一。我们假设在 DRF 手术时在骨折部位进行有限的桡骨牵开将在功能上等同于间接 USO，如果在尺骨阳性患者中进行该操作，则可能降低 USWP 的风险。
这项回顾性研究在一家单机构进行，所有手术均由单名外科医生完成。共纳入 136 名患者（92 名女性和 44 名男性），平均年龄为 55 岁，其中 57 名患者在牵开组（2014 年至 2017 年），79 名患者在非牵开组（2011 年至 2013 年）。患者接受了 USWP 评估。使用手臂、肩部和手残疾问卷（DASH）、疼痛视觉模拟量表（VAS）、握力和手腕活动范围评估功能结果。
平均随访时间为 37.9 个月（范围 28-61 个月）。术后 2 年的 X 线片显示，牵开组的平均尺骨阳性变异为 1.3mm（范围 1-2mm），而非牵开组为 3.5mm（范围 2-5mm）。牵开长度的平均值为 2.32mm（范围 2-3mm）。在 2 年的随访中，牵开组有 7%（4 例）出现 USWP，明显低于非牵开组的 28%（22 例）。牵开组的 DASH 评分和握力明显更好，且随后因尺侧腕痛而行尺骨缩短截骨术的比例较低。
在桡骨远端骨折固定过程中进行桡骨牵开术可能会降低术后 USWP 的发生，并改善功能结果。
III 级，治疗性。
