Department of Orthopedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
J Orthop Surg Res. 2024 Apr 4;19(1):223. doi: 10.1186/s13018-024-04689-w.
Concomitant injuries to the radiocarpal ligaments may occur during episodes of distal radius fractures, which may not cause acute subluxation or dislocation but can lead to radiocarpal instability and progress over time. This study aimed to analyze the occurrence of ulnar carpal translation (UCT) after open reduction and internal fixation of distal radius fractures and evaluate the associated factors of UCT.
The retrospective study has been done now and includes patients treated between 2010 and 2020 who had undergone reduction and locking plate fixation of distal radius fractures. We assessed radiographs taken immediately after the operation and at 3 months post-operation, enrolling patients with UCT for evaluation. In addition to demographic data, we evaluated radiographic parameters, including fracture pattern, fragment involvement, and ulnar variance. We also assessed the palmar tilt-lunate (PTL) angle to determine associated rotatory palmar subluxation of the lunate (RPSL).
Among the 1,086 wrists, 53 (4.9%) had UCT within 3 months post-operation. The majority of wrists with UCT exhibited normal to minus ulnar variance (49 wrists; mean: -1.1 mm), and 24 patients (45.3%) had concomitant RPSL. Fracture classification was as follows: 19 type A3 (35.8%), 5 type C1 (9.4%), 11 type C2 (20.8%), and 18 type C3 (34.0%). Radial styloid was involved in 20 wrists (37.7%), palmar rim in 18 wrists (34.0%), dorsal rim in 25 wrists (47.2%), and die-punch fractures in 3 wrists (5.7%). Concomitant ulnar styloid fractures were present in 29 wrists (54.7%).
This study highlights the potential for UCT to occur following reduction and fixation of distal radius fractures, particularly in cases with a more severe fracture pattern and combined with ulnar minus variance. The high incidence of concomitant RPSL provides further evidence for the possibility of associated radiocarpal ligament insufficiency after distal radius fracture.
桡骨远端骨折时可能同时伴有桡腕背侧韧带损伤，虽然这种损伤可能不会导致急性半脱位或脱位，但会导致桡腕关节不稳定，并随着时间的推移而进展。本研究旨在分析切开复位内固定治疗桡骨远端骨折后发生尺侧腕骨平移（UCT）的情况，并评估 UCT 的相关因素。
这是一项回顾性研究，纳入了 2010 年至 2020 年间接受切开复位锁定钢板内固定治疗桡骨远端骨折的患者。我们评估了术后即刻和术后 3 个月的影像学资料，纳入了发生 UCT 的患者进行评估。除了人口统计学数据外，我们还评估了影像学参数，包括骨折类型、骨折块累及情况和尺侧骨量。我们还评估了掌倾角-月骨倾斜角（PTL）以确定月骨的旋前性掌侧半脱位（RPSL）。
在 1086 例腕关节中，术后 3 个月内有 53 例（4.9%）发生 UCT。大多数发生 UCT 的腕关节表现为正常或负性尺侧骨量（49 例；平均：-1.1mm），24 例患者（45.3%）同时存在 RPSL。骨折分类如下：A3 型 19 例（35.8%）、C1 型 5 例（9.4%）、C2 型 11 例（20.8%）和 C3 型 18 例（34.0%）。桡骨茎突累及 20 例（37.7%）、掌侧缘 18 例（34.0%）、背侧缘 25 例（47.2%）和月骨钻孔骨折 3 例（5.7%）。同时存在尺骨茎突骨折的有 29 例（54.7%）。
本研究强调了桡骨远端骨折复位固定后发生 UCT 的可能性，特别是在骨折类型更严重且合并尺侧负性骨量的情况下。同时存在 RPSL 的发生率较高进一步提示桡骨远端骨折后可能存在相关的桡腕背侧韧带功能不全。
