Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
J Hand Surg Asian Pac Vol. 2023 Dec;28(6):708-716. doi: 10.1142/S2424835523500753. Epub 2023 Dec 5.
We treated distal radius fractures (DRFs) beyond the watershed line without fracture of the lunate volar rim using a volar locking plate (VLP) and report the radiological and clinical outcomes at least 3 years after surgery. In 41 consecutive patients between January 2012 and August 2017, the fragment was composed of the radial styloid process (distal to the watershed line) and the lunate volar rim was intact. We evaluated demographic factors, radiological features and radiological/clinical outcomes at the final follow-up. Twenty-nine patients were followed and evaluated. The mean follow-up period was 5.7 years. The mean patient age was 52.7 years and 24 patients had intracapsular intra-articular fractures. The fracture line was present in the lunate fossa in all patients. Twenty patients were classified as Soong grade 2, and five and four patients were grades 1 and 0, respectively. No radiological parameter (volar tilt, radial inclination, step-off and ulnar variance) was significantly different between the affected and contralateral normal sides. The mean visual analogue scale pain score and Disabilities of the Arm, Shoulder and Hand score, as well as the range of movement of the wrist, were not different between the affected and contralateral normal wrists. Finally, the grip strength on the affected side was 92% of the contralateral value. Major complications, such as nonunion, malunion and tendon rupture, were absent. DRFs distal to the watershed line with an intact lunate volar rim are rare and easy to miss. Careful inspection of 3D-CT images is necessary to determine these injuries, and the optimal choice for proper fixation of the fragment amongst the commercial VLPs would result in satisfactory radiological and clinical outcomes. Level IV (Therapeutic).
我们使用掌侧锁定板（VLP）治疗分水岭线以外的桡骨远端骨折（DRF），且月骨掌侧缘无骨折，报告至少 3 年后的影像学和临床结果。在 2012 年 1 月至 2017 年 8 月的 41 例连续患者中，骨折块由桡骨茎突（分水岭线远端）组成，月骨掌侧缘完整。我们评估了人口统计学因素、影像学特征以及最终随访时的影像学/临床结果。29 例患者接受随访和评估。平均随访时间为 5.7 年。平均患者年龄为 52.7 岁，24 例为囊内关节内骨折。所有患者的骨折线均位于月骨窝内。20 例患者为 Soong 分级 2，5 例和 4 例分别为 1 级和 0 级。掌倾角、桡骨倾斜角、台阶差和尺侧偏距等影像学参数在患侧与对侧正常侧之间无显著差异。腕关节活动度、视觉模拟评分疼痛量表和上肢功能障碍评分（DASH）均值在患侧与对侧正常侧之间无差异。最后，患侧握力为对侧的 92%。无主要并发症，如骨不连、畸形愈合和肌腱断裂。分水岭线以外的桡骨远端骨折且月骨掌侧缘完整较为罕见且容易漏诊。需要仔细检查 3D-CT 图像以确定这些损伤，并且商业 VLP 中适当固定骨折块的最佳选择将产生满意的影像学和临床结果。IV 级（治疗）。
