Dondapati Akhil, Carroll Thomas J, Hammert Warren C, Gonzalez Ronald, Ketonis Constantinos
Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY.
Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY.
J Hand Surg Am. 2025 Jan 30. doi: 10.1016/j.jhsa.2024.12.016.
Dorsal bridge plating (DBP) can effectively treat complex distal radius fractures (DRFs); however, techniques for metacarpal fixation vary. The purpose of our study was to compare range of motion (ROM), grip strength, patient-reported outcomes, radiographic parameters, and complication rates between patients undergoing DBP with fixation to the second versus third metacarpal for DRFs.
We retrospectively analyzed 432 patients with DRFs. Wrist ROM and radiographic data were calculated at the 6-month follow-up. We calculated Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity, physical function, and pain interference at each visit. Additional data collected included surgical complications and demographic data. Statistical analysis was conducted via multivariate analysis, t tests, and chi-square tests.
A total of 329 patients underwent DBP to the second metacarpal, whereas 103 patients underwent DBP to the third. Demographics and comorbidities were similar between the groups. Tendon rupture was more common in the third metacarpal group (3.9% vs 0.9%), with two extensor pollicis longus and one extensor indicis proprius ruptures in each group and an unspecified tendon in the third metacarpal cohort. All other complication rates were similar. The second metacarpal group demonstrated greater wrist flexion (57.8° vs 56.2°), ulnar deviation (23.9° vs 20.7°), and grip strength (62.3% vs 57.8%). All other ROM measurements were similar. There was no difference in PROMIS metrics at the 6-month follow-up. The second metacarpal group demonstrated greater radial inclination (21.3° vs 19.5°) and less volar tilt (6.8° vs 7.1°).
Dorsal bridge plating to the second metacarpal demonstrated greater ROM, grip strength, and radial inclination, similar PROMIS scores, and lower extensor tendon rupture rates than third metacarpal fixation. Although there were differences between techniques, their clinical relevance is unclear. Dorsal bridge plating to the second or third metacarpal both result in acceptable outcomes and can be considered based on the fracture pattern and surgeon preference.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
背侧桥式钢板固定术（DBP）可有效治疗复杂桡骨远端骨折（DRF）；然而，掌骨固定技术各不相同。我们研究的目的是比较采用DBP治疗DRF时，固定于第二掌骨与第三掌骨的患者之间的活动范围（ROM）、握力、患者报告的结果、影像学参数及并发症发生率。
我们回顾性分析了432例DRF患者。在6个月随访时计算腕关节ROM和影像学数据。每次随访时计算患者报告的结果测量信息系统（PROMIS）上肢、身体功能及疼痛干扰情况。收集的其他数据包括手术并发症和人口统计学数据。通过多变量分析、t检验和卡方检验进行统计分析。
共有329例患者接受了第二掌骨的DBP，而103例患者接受了第三掌骨的DBP。两组的人口统计学和合并症相似。第三掌骨组肌腱断裂更常见（3.9%对0.9%），每组各有2例拇长伸肌腱和1例示指固有伸肌腱断裂，第三掌骨队列中有1例未明确的肌腱断裂。所有其他并发症发生率相似。第二掌骨组表现出更大的腕关节屈曲（57.8°对56.2°）、尺偏（23.9°对20.7°）和握力（62.3%对57.8%）。所有其他ROM测量值相似。6个月随访时PROMIS指标无差异。第二掌骨组表现出更大的桡骨倾斜度（21.3°对19.5°）和更小的掌倾角（6.8°对7.1°）。
与第三掌骨固定相比，第二掌骨的背侧桥式钢板固定术表现出更大的ROM、握力和桡骨倾斜度，PROMIS评分相似，伸肌腱断裂率更低。虽然技术之间存在差异，但其临床相关性尚不清楚。第二或第三掌骨的背侧桥式钢板固定术均能产生可接受的结果，可根据骨折类型和外科医生的偏好来考虑。
研究类型/证据水平：治疗性IV级。
