Mireadeli Abulimiti, Qu Wanming, Zhu Tianbo, Zhang Daoxin, Zhu Xiaokang, Li Xinzhi, Chen Wenyao
Department of Orthopaedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang Hubei, 443001, P. R. China.
Department of Orthopaedics, Yiling People's Hospital of Yichang City, Yichang Hubei, 443100, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Jun 15;39(6):662-667. doi: 10.7507/1002-1892.202503049.
To investigate the surgical technique and effectiveness of tension band-assisted plate fixation combined with external fixator for volar marginal fractures of the distal radius.
A retrospective analysis was performed on the clinical data of 12 patients with volar marginal fractures of the distal radius treated by Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator between October 2018 and July 2023. The cohort included 9 males and 3 females, aged from 20 to 52 years (mean, 35.5 years). The injury causes included traffic accidents in 6 cases, falls from height in 3 cases, and fall in 3 cases. According to AO/Orthopaedic Trauma Association (AO/OTA), there were 1 case of type B2, 4 cases of type B3, 2 cases of type C1, 3 cases of type C2, and 2 cases of type C3. According to Fernandez classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ, and 5 cases of type Ⅴ. Associated injuries included radiocarpal joint dislocation or subluxation in 7 cases and median nerve injury in 2 cases. The time from injury to operation was 2-7 days (mean, 3.2 days). Postoperatively, functional outcomes were evaluated using the modified Mayo wrist score and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Grip strength was measured as the ratio to the unaffected side, and wrist range of motion (ROM) including dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was assessed.
All procedures were successfully completed, with an operation time of 55-110 minutes (mean, 65 minutes). All patients were followed up 6-36 months (mean, 13.7 months). Surgical incisions healed by first intention, without complications such as vascular-nerve injury or infection. Bony union and articular congruency were attained in all patients, with a healing time of 3-5 months (mean, 3.8 months). During follow-up, 1 case of Kirschner wire migration occurred with no instances of infections, radiocarpal dislocations, internal fixation failures, or extensor pollicis longus tendon ruptures. At last follow-up, the modified Mayo wrist score ranged from 65 to 92 (mean, 80.8), the DASH score ranged from 7 to 15 (mean, 11.6), the grip strength was 65%-90% (mean, 78.2%) of the unaffected side; and wrist ROM was palmar flexion 60°-85° (mean, 77.4°), dorsiflexion 55°-80° (mean, 74.8°), radial deviation 10°-25° (mean, 18.8°), and ulnar deviation 15°-30° (mean, 24.5°).
Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator for volar marginal fractures of the distal radius is a simple method with reliable fixation, which can achieve satisfactory effectiveness.
探讨克氏针张力带辅助钢板固定联合外固定器治疗桡骨远端掌侧边缘骨折的手术技术及疗效。
回顾性分析2018年10月至2023年7月采用克氏针张力带辅助解剖钢板固定联合外固定器治疗的12例桡骨远端掌侧边缘骨折患者的临床资料。该队列包括9例男性和3例女性，年龄20至52岁（平均35.5岁）。损伤原因包括交通事故6例，高处坠落3例，跌倒3例。根据AO/骨科创伤协会（AO/OTA）分类，B2型1例，B3型4例，C1型2例，C2型3例，C3型2例。根据Fernandez分类，Ⅲ型2例，Ⅳ型5例，Ⅴ型5例。合并伤包括桡腕关节脱位或半脱位7例，正中神经损伤2例。受伤至手术时间为2至7天（平均3.2天）。术后采用改良梅奥腕关节评分和上肢、肩部和手部功能障碍（DASH）问卷评估功能结局。测量握力并计算其与健侧的比值，评估腕关节活动度（ROM），包括背伸、掌屈、尺偏和桡偏。
所有手术均顺利完成，手术时间为55至110分钟（平均65分钟）。所有患者均获随访6至36个月（平均13.7个月）。手术切口一期愈合，未发生血管神经损伤或感染等并发症。所有患者均达到骨愈合和关节面平整，愈合时间为3至5个月（平均3.8个月）。随访期间，发生1例克氏针移位，未发生感染、桡腕关节脱位、内固定失败或拇长伸肌腱断裂。末次随访时，改良梅奥腕关节评分65至92分（平均80.8分），DASH评分7至15分（平均11.6分），握力为健侧的65%至90%（平均78.2%）；腕关节ROM为掌屈60°至85°（平均77.4°），背伸55°至80°（平均74.8°），桡偏10°至25°（平均18.8°），尺偏15°至30°（平均24.5°）。
克氏针张力带辅助解剖钢板固定联合外固定器治疗桡骨远端掌侧边缘骨折是一种操作简单、固定可靠的方法，可取得满意疗效。
