Department of Orthopaedics and Traumatology, Ordu University Training and Research Hospital, Ordu, Türkiye.
Department of Orthopaedics and Traumatology, Eskisehir City Hospital, Eskisehir, Türkiye.
J Hand Surg Am. 2024 Nov;49(11):1104-1110. doi: 10.1016/j.jhsa.2024.07.006. Epub 2024 Aug 12.
This study investigated the effectiveness of volar plate surgery in patients with distal radius fractures (DRFs) initially treated nonsurgically but later experiencing reduction loss during follow-ups. Specifically, it assessed the impact of early surgery (E) (<3 weeks) versus delayed surgery (D) (3-6 weeks) on wrist function in surgically treated DRFs.
This retrospective study included 131 patients who underwent surgery after loss of reduction. Among them, 42 patients had delayed surgery, whereas 89 received early surgical treatment. The mean follow-up duration was 18 months. The primary outcome measure was Disabilities of the Arm, Shoulder, and Hand scores. Secondary outcomes included Short Form-12 physical component summary and mental component summary scores, postoperative range of motion, and radiological measurements such as radial length, radial inclination angle, and volar tilt angle. Fracture types were categorized using Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification based on radiological images.
All 131 DRFs achieved radiological union. Mean Disabilities of the Arm, Shoulder, and Hand scores were 8.0 (range, 0-78) and 10.8 (range, 0-73) for groups E and D, respectively, and the difference was not considered clinically relevant. Short Form-12 physical component summary scores (49.4 for E; 45.3 for D) and Short Form-12 mental component summary scores (52.3 for E; 53.5 for D) were similar in the two groups. Radiological measurements and range of motion were similar in the two groups. Complications, including carpal tunnel syndrome, superficial radial nerve neuropraxia, and complex regional pain syndrome, occurred in 12 (13.5%) E group patients and 9 (21.4%) D group patients.
Clinical and radiological results of early and delayed surgery after loss of reduction in secondary displaced DRF were similar. However, complication rates were higher in delayed surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
本研究旨在探讨对初始非手术治疗但随访过程中出现复位丢失的桡骨远端骨折（DRF）患者行掌侧钢板手术的疗效。具体而言，评估早期手术（E）（<3 周）与延迟手术（D）（3-6 周）对接受手术治疗的 DRF 患者腕关节功能的影响。
本回顾性研究纳入了 131 例复位丢失后接受手术治疗的患者。其中，42 例患者行延迟手术，89 例患者行早期手术。平均随访时间为 18 个月。主要结局测量指标为上肢功能障碍评分（DASH）。次要结局指标包括健康调查简表 12 项（SF-12）的生理成分评分和心理成分评分、术后活动范围以及放射学测量值，如桡骨长度、桡骨倾斜角和掌倾角。骨折类型根据放射影像学图像采用 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association 分类进行分类。
所有 131 例 DRF 均达到影像学愈合。E 组和 D 组的 DASH 评分分别为 8.0（范围，0-78）和 10.8（范围，0-73），差异无临床意义。E 组和 D 组的 SF-12 生理成分评分（分别为 49.4 和 45.3）和 SF-12 心理成分评分（分别为 52.3 和 53.5）相似。两组的放射学测量值和活动范围相似。E 组有 12 例（13.5%）和 D 组有 9 例（21.4%）患者发生并发症，包括腕管综合征、桡浅神经神经麻痹和复杂性区域疼痛综合征。
复位丢失后继发性移位 DRF 行早期和延迟手术的临床和放射学结果相似，但延迟手术的并发症发生率更高。
类型的研究/证据水平：预后 IV 级。
