Gengatharan Dhivakaran, Wong Walter, Chia Dawn S
Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP.
Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore, SGP.
Cureus. 2024 May 19;16(5):e60595. doi: 10.7759/cureus.60595. eCollection 2024 May.
Background The introduction of locking plate technology has improved the feasibility of distal radius fracture fixation without the need for bone grafting, yet challenges persist in cases of severely comminuted fractures and small, unstable intra-articular fragments. This study aimed to assess the outcomes of bone grafting in severely comminuted distal radius fractures treated with locking plates. Methods We performed a retrospective analysis involving 450 patients who underwent distal radius fracture fixations. We evaluated wrist motion, grip strength, and radiographic parameters, including radial inclination, radial tilt, ulnar variance, articular step, and fracture union at standardized intervals. In addition, at the 12- and 24-month marks, we assessed the disabilities of the arm, shoulder, and hand (DASH) questionnaire score. Results Out of the 450 patients who underwent distal radius fracture fixation using volar locking plate systems, 59 individuals (13%) required either autologous bone graft (n = 24) or synthetic bone substitutes (n = 35). In the final follow-up, all fractures had successfully united, displaying an average volar tilt of 4°, radial inclination of 18.8°, and an articular step or gap of 0.1 mm. Conclusion There was no significant difference between the use of autologous or synthetic bone grafts on clinical or radiological outcomes in the long term. Bone grafts are useful in severe metaphyseal comminution and aid in the reduction of articular fragments and bi-cortical comminution.
背景 锁定钢板技术的引入提高了桡骨远端骨折固定的可行性，无需植骨，但在严重粉碎性骨折以及小的、不稳定的关节内骨折块的病例中，挑战依然存在。本研究旨在评估在使用锁定钢板治疗的严重粉碎性桡骨远端骨折中植骨的效果。方法 我们对450例行桡骨远端骨折固定术的患者进行了回顾性分析。我们在标准化时间间隔评估腕关节活动度、握力和影像学参数，包括桡骨倾斜度、桡骨倾角、尺骨变异、关节台阶和骨折愈合情况。此外，在12个月和24个月时，我们评估了上肢、肩部和手部功能障碍（DASH）问卷评分。结果 在450例使用掌侧锁定钢板系统进行桡骨远端骨折固定的患者中，59例（13%）需要自体骨移植（n = 24）或人工骨替代物（n = 35）。在最终随访中，所有骨折均成功愈合，平均掌侧倾斜度为4°，桡骨倾斜度为18.8°，关节台阶或间隙为0.1 mm。结论 长期来看，自体骨移植或人工骨替代物在临床或影像学结果上没有显著差异。骨移植在严重干骺端粉碎性骨折中有用，有助于关节骨折块的复位和双皮质粉碎性骨折的治疗。
