PDF(Pubmed)
Abstract：
Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP. Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020. Patients < 18 years old, < 8 weeks\' follow-up, open fractures, ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient demographics, specific construct type, AO fracture classification, ROM, and complications were assessed. ROM was calculated using average flexion, extension, supination, and pronation. t -Tests were used to determine differences in ROM among construct types. Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation. No significant differences were identified when comparing final wrist flexion ( p = 0.08), extension ( p = 0.33), supination ( p = 0.35), or pronation ( p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%). Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4). Conclusion Construct type does not appear to affect final ROM if stable internal fixation is achieved. SVP and FSF had similar complication rates; however, double volar hook constructs resulted in increased reoperations likely from fixation failure and plate prominence. Level of Evidence Level IV, retrospective review.
摘要：
背景技术桡骨远端关节内骨折(DRFs)的治疗依赖于解剖内固定。当断裂模式对于标准掌侧钢板(SVP)来说过于复杂时，应用碎片特异性固定(FSF)。经常有潜在的并发症风险增加。我们假设接受FSF的患者与SVP相比，腕关节活动范围（ROM）较小，并发症风险较高。方法回顾性分析2017年至2020年连续159例DRF固定术患者的临床资料。患者年龄<18岁，<8周随访，开放性骨折,同侧创伤,排除了需要背侧跨越钢板的骨折。患者人口统计学，特定结构类型，AO断裂分类,ROM,并对并发症进行了评估。使用平均屈曲计算ROM，扩展,仰卧起坐,和内旋。t检验用于确定构建体类型之间ROM的差异。结果92例患者符合所有纳入标准：59例接受SVP，33例接受FSF。接受SVP的患者的平均腕部ROM为57度/50度屈伸和87度/88度旋旋；接受FSF的患者的平均ROM为55度/49度屈伸和88度/89度旋旋。当比较最终腕关节屈曲时，没有发现显著差异(p=0.08)，扩展（p=0.33），旋后（p=0.35），或内旋（p=0.21）。FSF（12％）与SVP（2％）的总再手术率为5％或更高。在双掌侧钩队列中观察到最高的再手术率(80%;N=4)。结论如果获得稳定的内固定，结构类型似乎不会影响最终的ROM。SVP和FSF的并发症发生率相似；然而，双掌侧钩结构可能由于固定失败和钢板突出而导致再次手术增加。证据级别IV级,回顾性审查。
