Bates Brent D, Persitz Jonathan, Noori Atefeh, Chan Andrea H W, Paul Ryan A
Division of Orthopaedics, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Hand Program, Division of Plastic, Reconstructive, and Aesthetic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Hand Surg Am. 2025 Aug;50(8):1011.e1-1011.e8. doi: 10.1016/j.jhsa.2024.07.025. Epub 2024 Sep 27.
The purpose of this study was to validate the clinical accuracy of the lift-off screw (LOS) technique for volar tilt correction (VTC) in patients undergoing corrective osteotomy for dorsally angulated distal radius fracture malunions.
We conducted a retrospective review of 23 patients with dorsally angulated distal radius fracture malunions treated with corrective osteotomy using the LOS technique. The LOS equation L = [tan(T) ∗ L + C]/[cos(⍬)] and standardized intraoperative fluoroscopic images were used to determine and compare the calculated and clinical VTC and final volar tilt. Correlations between the LOS length and the clinical VTC were calculated, as well as between the desired VTC and the correction accuracy.
Preoperative volar tilt ranged from -6° to -50° (mean = -22.9° ± 10.6°). The calculated VTC was 32.7° ± 9.4°, and the clinical VTC achieved was 25.8° ± 9.3°. The difference between the clinical and calculated correction was -6.9°, with an average postoperative clinical volar tilt of 2.8° ± 5.7°, compared with a calculated volar tilt of 9.7° ± 4.4°. There was a moderately strong positive correlation between LOS screw length and clinical VTC achieved, and a moderately weak negative correlation between the desired amount of correction and the accuracy of the correction.
The LOS technique is a reproducible method to plan the amount of sagittal plane correction during corrective osteotomy surgery for dorsally angulated distal radius fracture malunions. We demonstrate that this technique underestimates the clinical correction achieved by an average of 7°, with larger deformities experiencing greater undercorrection. Undercorrection of volar tilt during corrective osteotomy should be anticipated by surgeons and considered in future implant and cutting guide designs.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在验证在接受背侧成角的桡骨远端骨折畸形愈合矫正截骨术的患者中，抬起螺钉（LOS）技术用于掌侧倾斜矫正（VTC）的临床准确性。
我们对23例采用LOS技术进行矫正截骨术治疗的背侧成角桡骨远端骨折畸形愈合患者进行了回顾性研究。使用LOS公式L = [tan(T) ∗ L + C]/[cos(⍬)]和标准化的术中透视图像来确定和比较计算得出的和临床的VTC以及最终的掌侧倾斜度。计算LOS长度与临床VTC之间的相关性，以及期望的VTC与矫正准确性之间的相关性。
术前掌侧倾斜度范围为-6°至-50°（平均=-22.9°±10.6°）。计算得出的VTC为32.7°±9.4°，实现的临床VTC为25.8°±9.3°。临床矫正与计算矫正之间的差异为-6.9°，术后平均临床掌侧倾斜度为2.8°±5.7°，而计算得出的掌侧倾斜度为9.7°±4.4°。LOS螺钉长度与实现的临床VTC之间存在中度强正相关，期望的矫正量与矫正准确性之间存在中度弱负相关。
LOS技术是一种可重复的方法，用于在背侧成角的桡骨远端骨折畸形愈合矫正截骨术期间规划矢状面矫正量。我们证明该技术平均低估了实现的临床矫正量7°，畸形越大，矫正不足越明显。外科医生应预期矫正截骨术期间掌侧倾斜矫正不足，并在未来的植入物和切割导板设计中予以考虑。
研究类型/证据水平：治疗性IV级。
