Faculty of Medicine Orthopedics and Traumatology Clinic, Kirsehir Ahi Evran University, Kirsehir, Turkey.
Medicine (Baltimore). 2024 Jun 14;103(24):e38509. doi: 10.1097/MD.0000000000038509.
This study aims to investigate the effectiveness of intraoperative stress radiographs in evaluating the stability and fixation adequacy of the dorso-ulnar fragment (DUF) after volar plate application. Sixty-four patients who underwent open reduction and internal fixation due to comminuted distal radius fracture accompanied by DUF between May 2020 and February 2022 were reviewed retrospectively. Two groups were compared, with and without stress radiographs used in addition to routine fluoroscopic imaging during the surgical treatment of distal radius fractures. DUF sizes and fracture classifications were made according to preoperative computed tomography. Displacement of the DUF, dorsal cortex screw penetration, and the number of screws inserted into the DUF were evaluated on immediate postoperative CT scans and direct radiographs. DUF displacement at the patients' last follow-up was significantly higher in the control group (1.62 mm) than in the additional stress fluoroscopy applied group (0.53 mm). It was observed that the amount of displacement increased as the dorso-volar size of the DUF decreased. No significant difference was observed in dorsal cortex screw penetrations between the 2 groups. In the additional stress fluoroscopy applied group, stabilization rates with at least 1 screw over volar-locking plate for DUF were significantly higher (P < .001). Compared to the stress fluoroscopy group, the change in ulnar variance (P < .001) and volar tilt (P < .001) was significantly higher in the control group in the last follow-up radiography. No significant difference was observed between the implant removal rates of both groups. Evaluation of the stability of the DUF with stress radiographs after fixation is an effective method to reveal the need for additional fixation. Dorsal stress radiographs allow dynamic evaluation of fixation strength.
本研究旨在探讨术中应片在评估掌侧钢板应用后尺骨背侧-桡侧骨块（DUF）稳定性和固定充分性方面的效果。回顾性分析了 2020 年 5 月至 2022 年 2 月因粉碎性桡骨远端骨折伴 DUF而行切开复位内固定的 64 例患者。比较了术中常规透视成像基础上加用应片和不加用应片两组患者的治疗效果。根据术前 CT 检查对 DUF 大小和骨折类型进行分类。在术后即刻 CT 扫描和直接 X 线片上评估 DUF 位移、背侧皮质螺钉穿透和插入 DUF 的螺钉数量。对照组（1.62mm）患者末次随访时 DUF 位移明显高于附加应透视组（0.53mm）。发现 DUF 背侧-掌侧尺寸越小，位移量越大。两组间背侧皮质螺钉穿透无显著差异。附加应透视组中，至少有 1 枚螺钉穿过掌侧锁定钢板固定 DUF 的稳定率明显更高（P＜.001）。与应透视组相比，对照组在末次随访 X 线片上尺侧偏距（P＜.001）和掌倾角（P＜.001）的变化明显更大。两组间的植骨取出率无显著差异。固定后用应片评估 DUF 的稳定性是一种有效的方法，可以揭示是否需要额外的固定。背侧应片可动态评估固定强度。
