Ye You-You, Shen Zhao-Qing, Wu Chun-Ling, Lin Yan-Bin
Department of Traumatic Orthopaedics, Fuzhou Second General Hospital, Fuzhou 350007, Fujian Province, China.
Department of Traumatic Orthopaedics, The Third Hospital of Zhangzhou, Zhangzhou 363000, Fujian Province, China.
World J Orthop. 2025 Jul 18;16(7):107913. doi: 10.5312/wjo.v16.i7.107913.
The volar approach with plate fixation is the gold standard for treating distal radius fractures, often requiring incision of the pronator quadratus (PQ) muscle. Preserving the PQ during surgery may facilitate early postoperative recovery. However, conventional minimally invasive plate osteosynthesis (MIPO) techniques frequently necessitate multiple (3-4) intraoperative fluoroscopic adjustments to achieve optimal plate positioning, which can inadvertently damage the PQ muscle. Based on our clinical observations, we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement. Preliminary results demonstrate promising early clinical outcomes.
To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.
The 3-point positioning technique was applied: The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ. With the aid of Kirschner wires positioning the PQ stripping was performed only once, and the plate then placed in a correct and satisfactory position. Operation time, incision length, wrist pain score, upper extremity function disabilities of the arm, shoulder and hand (DASH) score, wrist Gartland-Werley score, wrist grip strength, and range of motion were among the quantitative variables recorded. Qualitative variables including AO fracture classification, intraoperative and postoperative complications were evaluated.
At a mean follow-up of 6.9 ± 0.8 months, the mean scar length was 25.4 ± 1.5 mm, the pain score was 0.7 ± 0.6, the DASH score for the upper limb was 4.7 ± 1.3, and the Gartland-Werley score for wrist function was 4.1 ± 1.1 at the last follow-up. Mean flexion was 97.3%, extension was 97.0%, pronation was 98.9%, supination was 98.9%, and grip strength was 86.6% compared to contralateral values. No unfavorable intraoperative or postoperative complications occurred.
The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.
掌侧入路钢板固定是治疗桡骨远端骨折的金标准，通常需要切开旋前方肌（PQ）。手术中保留PQ可能有助于术后早期恢复。然而，传统的微创钢板接骨术（MIPO）技术常常需要在术中进行多次（3 - 4次）透视调整以实现钢板的最佳定位，这可能会无意中损伤PQ肌肉。基于我们的临床观察，我们开发了一种新颖的三点定位技术，以在确保钢板准确放置的同时尽量减少PQ损伤。初步结果显示出良好的早期临床疗效。
回顾性分析采用保留PQ的三点定位辅助MIPO技术治疗的桡骨远端骨折。
应用三点定位技术：透视后插入克氏针，并将钢板位置在PQ上方正确调整。借助克氏针定位，PQ剥离仅进行一次，然后将钢板放置在正确且满意的位置。记录的定量变量包括手术时间、切口长度、腕部疼痛评分、上肢（手臂、肩部和手部）功能障碍评分（DASH）、腕部Gartland - Werley评分、腕部握力和活动范围。评估的定性变量包括AO骨折分类、术中及术后并发症。
平均随访6.9±0.8个月，末次随访时平均瘢痕长度为25.4±1.5mm，疼痛评分为0.7±0.6，上肢DASH评分为4.7±1.3，腕部功能Gartland - Werley评分为4.1±1.1。与对侧相比，平均屈曲为97.3%，伸展为97.0%，旋前为98.9%，旋后为98.9%，握力为86.6%。未发生不良术中或术后并发症。
三点定位技术可能减少对PQ肌肉的损伤，是一种用于桡骨远端骨折MIPO的安全有效方法。
