Kaya Emre, Keçeci Tolga
Department of Orthopaedics&Traumatology, Istanbul Kent University, Istanbul, Turkey.
Department of Orthopaedics&Traumatology, Ordu University Hospital, Turkey.
J Orthop Sci. 2025 Sep;30(5):816-823. doi: 10.1016/j.jos.2025.04.013. Epub 2025 May 6.
Complications related to implant placement can occur during the surgical treatment of displaced distal radius fractures (DRF) with a volar locking plate(VLP). The literature has often focused on implant placement in the sagittal plane, whereas the coronal plane has been neglected. The purpose of this study was to evaluate the effect of VLP protrusions in the coronal plane in the surgical treatment of DRF.
Between 2015 and 2022, 302 patients who underwent DRF surgery with VLP between 2015 and 2022 were included in the study. Patients were divided into group 1(anatomically located VLP) and group 2 (protruding VLP and/or screw cutout in the coronal plane), and statistically compared. Patients with radiocarpal intra-articular and sagittal plane protrusions, neurological problems, preoperative DRUJ injury, previous fracture or surgery in the ipsilateral upper extremity, malunion, or incomplete data were excluded. Patients with at least two years of follow-up were included in the study. The Fernandez classification was used for fracture classification. Group 2 patients were classified into subgroups according to the anatomical location of the protrusions: group A (metaphyseal radial styloid side), group B (ulnar metaphyseal side), and group C (diaphyseal side). Functional outcomes were statistically compared between subgroups in terms of the amount of protrusion (≥2 mm and <2 mm), brachioradialis (BR) and abductor pollicis longus (APL) tenosynovitis, distal radioulnar joint (DRUJ) irritation, and necessity for plate removal surgery. QuickDash and PRWE scores were used to assess functional outcomes.
PRWE, QuickDash scores, and plate removal rates were higher in group 2 (p < 0.05).The demographic and radiological parameters were similar between the groups (P > 0.05).Within group 2, functional scores, BR and/or APL tendinitis, and plate removal were higher in group A cases with protrusion ≥2 mm and in group B cases with screw prominence in the DRUJ, whereas no difference was found between group A cases with protrusion <2 mm, group B caseswith pure protrusion of the VLP without screw, and all group C cases. All cases requiring plate removal were in group A ≥2 mm and had BR and/or APL tenosynovitis, and in group B with screws penetrating the DRUJ. Functional scores improved significantly after plate removal in all patients requiring plate removal (p < 0.05).
≥2 mm protrusion in group A and group B cases with screw cutout to the DRUJ, the results are unsatisfactory and implant removal is required in these cases. If the screw hole was left empty in the protruded VLP in group B and in all group C cases, clinical outcomes were not significantly affected.
在采用掌侧锁定钢板（VLP）手术治疗桡骨远端移位骨折（DRF）的过程中，可能会出现与植入物放置相关的并发症。文献通常关注矢状面的植入物放置，而冠状面则被忽视。本研究的目的是评估VLP在冠状面的突出情况对DRF手术治疗的影响。
纳入2015年至2022年间302例行VLP治疗DRF手术的患者。患者分为1组（解剖位置合适的VLP）和2组（冠状面突出的VLP和/或螺钉穿出），并进行统计学比较。排除桡腕关节内骨折、矢状面突出、神经问题、术前下尺桡关节损伤、同侧上肢既往骨折或手术、畸形愈合或数据不完整的患者。纳入至少随访两年的患者。采用Fernandez分类法进行骨折分类。2组患者根据突出部位的解剖位置分为亚组：A组（干骺端桡骨茎突侧）、B组（尺侧干骺端侧）和C组（骨干侧）。就突出量（≥2mm和<2mm）、肱桡肌（BR）和拇长展肌（APL）腱鞘炎、下尺桡关节（DRUJ）刺激以及取出钢板手术的必要性等方面，对亚组间的功能结局进行统计学比较。采用QuickDash和PRWE评分评估功能结局。
2组的PRWE、QuickDash评分和钢板取出率更高（p<0.05）。两组间的人口统计学和放射学参数相似（P>0.05）。在2组内，突出≥2mm的A组病例以及DRUJ处有螺钉突出的B组病例，其功能评分、BR和/或APL肌腱炎以及钢板取出率更高，而突出<2mm的A组病例、单纯VLP突出无螺钉的B组病例与所有C组病例之间未发现差异。所有需要取出钢板的病例均在突出≥2mm的A组且伴有BR和/或APL腱鞘炎，以及螺钉穿透DRUJ的B组。所有需要取出钢板的患者在取出钢板后功能评分显著改善（p<0.05）。
A组突出≥2mm以及B组螺钉穿出至DRUJ的病例，结果不理想，这些病例需要取出植入物。如果B组突出的VLP和所有C组病例的螺钉孔为空，临床结局未受到显著影响。
