Ferlauto Harrison R, Inglesby Dani, Barnett Joshua, Agriantonis George, Melamed Eitan
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Surgery, Elmhurst Hospital Center, Elmhurst, NY, United States.
Department of Surgery, Elmhurst Hospital Center, Elmhurst, NY, United States; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Hand Surg Rehabil. 2025 Feb;44(1):102047. doi: 10.1016/j.hansur.2024.102047. Epub 2024 Dec 2.
Tendon-related complications comprise a significant portion of overall complications following volar locked plating of distal radius fractures. While much is known about the effect of prominent hardware in the volar and dorsal metaepiphyseal region of the distal radius, less is known about the effect of hardware prominence in the dorsal meta-diaphyseal region. The purpose of this anatomic study was to evaluate the safety of dorsal screw penetration at the proximal holes of volar locking plates. We applied a 7-hole volar locking plate to the distal radius of 10 cadaver forearms. Screws were intentionally protruding on the dorsal side. Measurements were taken from each protruding dorsal screw-tip to the nearest point on the abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor digitorum communis, noting whether the nearest point was on the tendon or muscle belly. Results indicated that the muscle bellies of the abductor pollicis longus and extensor pollicis brevis were the structures most at risk from dorsal screw prominence, and that there was a smooth transition from the extensor pollicis brevis to abductor pollicis longus being the focus of risk as one moves from distal to proximal along the plate. The extensor pollicis brevis was most at risk at hole 3, and the abductor pollicis longus was most at risk at hole 6. All cases of direct contact between a protruding screw and the abductor pollicis longus or extensor pollicis brevis consisted of contact with the muscle belly, not the tendon. Average anteroposterior distal radius thickness ranged from 13.9 mm at the most distal proximal screw hole to 11.5 mm at the most proximal screw hole. We also found that the extensor pollicis longus tendon was at risk of contact with a protruding screw, but only at the most distal proximal screw hole. Overall, dorsal screw penetration at the proximal holes of volar locking plates appeared to be safe, particularly as one moves proximally along the plate.
肌腱相关并发症在桡骨远端骨折掌侧锁定钢板固定术后的总体并发症中占很大比例。虽然对于桡骨远端掌侧和背侧干骺端区域内突出的内固定物的影响已有很多了解，但对于背侧骨干-干骺端区域内固定物突出的影响了解较少。本解剖学研究的目的是评估掌侧锁定钢板近端孔处背侧螺钉穿出的安全性。我们将一块7孔掌侧锁定钢板应用于10具尸体前臂的桡骨远端。故意使螺钉在背侧突出。测量每个突出的背侧螺钉尖端到拇长展肌、拇短伸肌、拇长伸肌和指总伸肌上最近点的距离，记录最近点是在肌腱还是肌腹上。结果表明，拇长展肌和拇短伸肌的肌腹是最易受到背侧螺钉突出影响的结构，并且随着沿钢板从远端向近端移动，拇短伸肌到拇长展肌作为风险焦点存在平稳过渡。拇短伸肌在第3孔处风险最高，拇长展肌在第6孔处风险最高。突出螺钉与拇长展肌或拇短伸肌直接接触的所有病例均为与肌腹接触，而非肌腱。桡骨远端前后平均厚度从最远端近端螺钉孔处的13.9毫米到最近端螺钉孔处的11.5毫米不等。我们还发现拇长伸肌腱有与突出螺钉接触的风险，但仅在最远端近端螺钉孔处。总体而言，掌侧锁定钢板近端孔处的背侧螺钉穿出似乎是安全的，尤其是沿钢板向近端移动时。
