Jakobsson Hugo, Lundqvist Eva, Nordkvist Sara, Dahlbom Kathe, Sagerfors Marcus
Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
School of Health Sciences, Örebro University, Sweden.
Hand (N Y). 2025 Sep 7:15589447251366459. doi: 10.1177/15589447251366459.
In distal radius fracture (DRF) surgery with volar locking plates, the flexor carpi radialis approach is commonly used. However, the volar central approach (VCA), between the median nerve and the finger flexors, may improve visualization of the volar ulnar corner. A similar approach has been linked with a higher risk of iatrogenic median neuropathy. This study evaluated the risk of median neuropathy after operative treatment using the VCA.
Thirty-eight patients with Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C DRF were assessed prospectively with sensory nerve conduction studies preoperatively and at 6 weeks, 3 months, and 12 months postoperatively.
At 6 weeks, 30 of the 38 patients exhibited median neuropathy, decreasing to 12 of the 35 at 12 months. Subjective sensory deficit was reported by 12 of the 38 patients at 6 weeks and 8 of the 37 at 12 months. Patients with median neuropathy (MN) had significantly higher frequency of subjective sensory deficit of the median nerve 12 months postoperatively, but did not have significantly worse patient-reported outcome.
Our results suggest that the VCA should be reserved for cases needing optimal exposure of the volar ulnar corner.
在使用掌侧锁定钢板治疗桡骨远端骨折（DRF）的手术中，通常采用桡侧腕屈肌入路。然而，位于正中神经和指屈肌之间的掌侧中央入路（VCA）可能会改善掌侧尺骨角的视野。类似的入路与医源性正中神经病变的较高风险有关。本研究评估了使用VCA进行手术治疗后正中神经病变的风险。
对38例 Arbeitsgemeinschaft für Osteosynthesefragen（AO）C型DRF患者进行前瞻性评估，术前以及术后6周、3个月和12个月进行感觉神经传导研究。
6周时，38例患者中有30例出现正中神经病变，12个月时35例中降至12例。38例患者中有12例在6周时报告有主观感觉障碍，37例中有8例在12个月时报告有主观感觉障碍。正中神经病变（MN）患者术后12个月正中神经主观感觉障碍的发生率显著更高，但患者报告的结果并没有明显更差。
我们的结果表明，VCA应保留用于需要最佳暴露掌侧尺骨角的病例。
