Usta Emirhan, Akpolat Ahmet O, Kahraman Ahmet N, Kara Adnan, Oc Yunus, Kilinc Bekir E
Department of Orthopaedics and Traumatology, Urfa Traning and Research Hospital, Sanliurfa, TUR.
Department of Orthopaedics and Traumatology, Health Sciences University, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR.
Cureus. 2022 Jun 30;14(6):e26444. doi: 10.7759/cureus.26444. eCollection 2022 Jun.
Literature does not show any studies regarding plate placement problems in the coronal plane of patients with volar plating due to distal radius fracture diagnosis. We aimed to investigate the functional and laboratory results of the coronal malposition of the volar locking plate in patients with distal radius fracture treated with internal fixation.
In this retrospective study, we included patients who had volar plate fixation, were aged between 18 and 80, had no pathological fracture, had a minimum of six months of follow-up, and had the same rehabilitation protocol. We consider the angle subtended on the coronal axis between the distal radius long axis and the distal radius locking plate as coronal malposition. We named the coronal malposition angle the "AYE Angle." Patients with an AYE angle of over 1 degree were evaluated under group 1. Patients with an AYE angle of 0-1 degrees were evaluated under group 2. Radiological parameters were taken from AP-Lateral X-ray views. Superficial University System of Georgia (USG) examinations were applied to detect tendon problems. The DASH and QUICK-DASH scoring systems were used for clinical evaluation. Grip strength was measured with a dynamometer in all patients. All results were compared between the two groups.
Thirteen patients were female and 27 patients were male. Nineteen patients who had coronal malposition were added to group 1, while 21 patients who had no coronal malposition were added to group 2. Fifteen patients had normal USG results in group 2, while 18 patients had edema around the flexor pollicis longus (FPL) tendon as a result of USG in group 1. Statistically, a significant difference was detected between the two groups in terms of the amount of tenosynovitis around FPL (p=0.01). A statistically significant relationship was found between USG grading and malposition grading. The study revealed that a higher rate of USG grade 2 was found in patients with malposition grade 2 (90.9%), while a higher rate of USG grade 1 (50%) was observed in patients with malposition grade 1 (p=0.01). A statistically significant difference was not found between Soong grading and USG in terms of the level of tenosynovitis around the FPL tendon. The amount of tenosynovitis detected around the FPL tendon was 62.5% for Soong and grade 0 level, 60.7% for grade 1 level, and 50% for grade 2 level. There was no statistically significant difference between the two groups in the DASH and QUICK-DASH scoring systems (p=0.96). There was no statistically significant difference between the two groups in the grip strength (p=0.52).
Coronal plate position in the treatment of the distal radius fracture is important to avoid potential flexor tendon problems. The volar plate position should be adjusted properly both in the coronal and sagittal axes.
文献中未显示任何关于因桡骨远端骨折诊断而进行掌侧钢板固定的患者在冠状面钢板放置问题的研究。我们旨在研究接受内固定治疗的桡骨远端骨折患者掌侧锁定钢板冠状面位置不良的功能和实验室结果。
在这项回顾性研究中，我们纳入了接受掌侧钢板固定、年龄在18至80岁之间、无病理性骨折、至少随访6个月且采用相同康复方案的患者。我们将桡骨远端长轴与桡骨远端锁定钢板在冠状轴上所夹的角度视为冠状面位置不良。我们将冠状面位置不良角度命名为“AYE角”。AYE角超过1度的患者归入第1组进行评估。AYE角为0至1度的患者归入第2组进行评估。放射学参数取自前后位-侧位X线片。应用浅表的佐治亚大学系统（USG）检查来检测肌腱问题。采用DASH和QUICK-DASH评分系统进行临床评估。所有患者均使用握力计测量握力。将两组的所有结果进行比较。
13例患者为女性，27例患者为男性。19例存在冠状面位置不良的患者被归入第1组，21例无冠状面位置不良的患者被归入第2组。第2组中有15例患者USG结果正常，而第1组中有18例患者因USG检查显示拇长屈肌腱（FPL）周围出现水肿。在统计学上，两组在FPL周围腱鞘炎的程度方面存在显著差异（p = 0.01）。发现USG分级与位置不良分级之间存在统计学上的显著关系。研究显示，位置不良2级的患者中USG 2级的发生率较高（90.9%），而位置不良1级的患者中USG 1级的发生率较高（50%）（p = 0.01）。在FPL肌腱周围腱鞘炎的程度方面，Soong分级与USG之间未发现统计学上的显著差异。Soong分级为0级时，FPL肌腱周围检测到的腱鞘炎程度为62.5%，1级时为60.7%，2级时为50%。两组在DASH和QUICK-DASH评分系统中无统计学上的显著差异（p = 0.96）。两组在握力方面无统计学上的显著差异（p = 0.52）。
在桡骨远端骨折的治疗中，冠状面钢板位置对于避免潜在的屈肌腱问题很重要。掌侧钢板位置应在冠状轴和矢状轴上均进行适当调整。
