Tanner Jean-Loup, Bossée-Pilon Antoine, Andro Christophe, Le Nen Dominique, Di Francia Rémi, Letissier Hoel
Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, Brest 29200, France.
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Clermont-Tonnerre (Hôpital d'Instruction des Armées), Rue Colonel Fonferrier, Brest 29240, France.
Orthop Traumatol Surg Res. 2025 Sep;111(5):104151. doi: 10.1016/j.otsr.2024.104151. Epub 2024 Dec 31.
With the aging population comes an increase in the number of distal radial fractures and therefore in the number of cases requiring volar locking plate (VLP) fixation. The complication rates after VLP fixation vary greatly from one study to the next. Several authors have already focused on these complications and how to lower their rate. The aim of this study was to identify risk factors for complications after VLP fixation of distal radial fractures that lead to implant removal.
Implant removal (except systematic removal) after VLP fixation can be predicted by risk factors for complication.
There were 2951 patients included in the study and divided into two groups: fixation without implant removal and fixation with implant removal. Then, intrinsic factors (age, sex, dominant side, tilt, type of fracture based on the AO classification (extra-articular - partial articular - complete articular - fracture); as well as one extrinsic factor (plate position according to the Soong classification compared to the watershed line) were identified. For all these factors, the relative risk (RR) was computed using univariate and multivariate models. The risk factors that reached statistical significance (p < 0.02) were used in the multivariate analysis.
The univariate and multivariate analyses identified three risk factors for complications, i.e. implant removal: being under 62 years of age (RR = 1.99; CI 1.56-2.54, p < 0.0001), type 2R3C fracture according to the AO classification (RR = 1.50; CI 1.17-1.93, p = 0.0050) and Soong grade 2 plate position (RR = 1.73; 1.32-2.26, p < 0.0001).
Our study showed that plate position recorded as grade 2 was a risk factor for complications and therefore implant removal. This is an extrinsic factor that is implant and surgeon dependent. Moreover, intrinsic factors were also identified such as age and type of fracture. Assessing these risk factors after VLP fixation of distal radial fractures may lead to early detection of these complications and an opportunity to propose implant removal as a preventive measure.
III.
随着人口老龄化，桡骨远端骨折的数量增加，因此需要掌侧锁定钢板（VLP）固定的病例数量也随之增加。VLP固定后的并发症发生率在不同研究中差异很大。已有几位作者关注这些并发症以及如何降低其发生率。本研究的目的是确定导致植入物取出的桡骨远端骨折VLP固定术后并发症的危险因素。
VLP固定后（系统性取出除外）的植入物取出可通过并发症的危险因素进行预测。
本研究纳入2951例患者，分为两组：未取出植入物的固定组和取出植入物的固定组。然后，确定了内在因素（年龄、性别、优势侧、倾斜度、基于AO分类的骨折类型（关节外 - 部分关节内 - 完全关节内 - 骨折））以及一个外在因素（根据宋氏分类与分水岭线相比的钢板位置）。对于所有这些因素，使用单变量和多变量模型计算相对风险（RR）。在多变量分析中使用达到统计学显著性（p < 0.02）的危险因素。
单变量和多变量分析确定了并发症（即植入物取出）的三个危险因素：年龄小于62岁（RR = 1.99；CI 1.56 - 2.54，p < 0.0001）、根据AO分类的2R3C型骨折（RR = 1.50；CI 1.17 - 1.93，p = 0.0050）和宋氏2级钢板位置（RR = 1.73；1.32 - 2.26，p < 0.0001）。
我们的研究表明，记录为2级的钢板位置是并发症及因此植入物取出的危险因素。这是一个依赖于植入物和外科医生的外在因素。此外，还确定了年龄和骨折类型等内在因素。评估桡骨远端骨折VLP固定术后的这些危险因素可能会导致对这些并发症的早期发现，并提供将植入物取出作为预防措施的机会。
III级
