Flexor tendon injuries following locked volar plating of distal radius fractures

We present 2 cases showing that flexor pollicis longus and flexor digitorum profundus index injury can occur after placement of 2 commonly used locked volar plates. In contrast with the literature, the radii healed in an anatomic position without plate lift-off. The patients presented 6 and 8 months after surgery with new onset of radial wrist pain and tenderness at the site of the plate and absence or weakness of the flexor pollicis longus. In both cases, the plate was positioned anterior to the distal radial rim on the lateral radiograph. We suggest close follow-up of all fractures in which the distal end of the plate is anterior to the radial rim and removal of hardware if symptoms suggest tendon irritation.     

Extensor pollicis longus entrapment in a paediatric distal radius fracture

This paper reports the rare phenomenon of entrapment of the Extensor Pollicis Longus (EPL) tendon in a wrist fracture and reviews the literature on this injury.     

Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study

PURPOSE: The aim of this study was to define the outcome after dorsal or volar plating of Association for Osteosynthesis (AO) type C3 distal radius fractures based on the fracture morphology. METHODS: Twenty-nine patients with AO type C3 distal radius fractures were surgically managed between 1996 and 2005. Group 1 (n = 15) had volar plating. Group 2 (n = 14) had dorsal plating. Outcomes were evaluated at an average of 22 months after surgery. Statistical analysis was performed using the Wilcoxon test and chi-square test. RESULTS: No significant differences were seen for the scores of Gartland and Werley, Castaing, Stewart I and II, Green and O'Brien, and Disability of the Arm, Shoulder and Hand between the 2 groups. The visual and verbal pain analog scales did not show significant differences between the 2 groups. Radiology analysis showed significant difference in comparison with the contralateral side in terms of dorsopalmar inclination (3 degrees +/- 3) and distal radioulnar joint angle (98 degrees +/- 8) for the patients in group 1, whereas there were no significant differences in group 2. The development of radiographic post-traumatic arthritis was significant in both groups. Significant functional differences were seen for flexion (45 degrees +/- 15) and hand span (20 cm +/- 2) in group 1 as well as for extension (37 degrees +/- 19), flexion (42 degrees +/- 12), and radial deviation (16 degrees +/- 10) in group 2. We found more complications after dorsal plate osteosynthesis than after volar plate osteosynthesis. CONCLUSIONS: This study shows satisfactory functional and subjective outcome results in both groups. Group 1 had non-significant better functional results than group 2, whereas both groups showed good to very good radiology results.     

背侧入路筋膜瓣覆盖钢板治疗桡骨远端粉碎性骨折

2006年8月-2009年8月,笔者采用背侧入路筋膜瓣覆盖T形钢板治疗桡骨远端粉碎性骨折30例,疗效满意。1材料与方法1.1病例资料本组30例,男8例,女22例,年龄51-82岁。左侧7例,右侧23例。按Melon分类：Ⅳ型12例,Ⅴ型18例。均为闭合骨折。     

Minimally invasive plate osteosynthesis for distal radius fractures

Background:

Fractures of distal radius are common injury in all age groups. Cast treatment with or without close reduction is a viable option. However, the results are often unsatisfactory with restricted function. The open reduction and internal fixation often results in extensive soft tissue dissection and associated high rates of infect and delayed/nonunion. The distractor/external fixator have reported good functional and anatomical results but the incidence of pin traction infection nerve injury and cosmedic deformity are high. We introduced a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for distal radial fracture and evaluated the functional outcomes and complications.

Materials and Methods:

22 distal radial fractures (10 left, 12 right) were treated using the MIPO technique and two small incisions with a palmar locking plate from August 2009 to August 2010. The wrist function was assessed according to Dienst wrist rating system, and postoperative complications were recorded.

Results:

According to Dienst wrist rating system, 13 patients showed excellent results, 6 cases showed good results and 3 patients had moderate results. No patient had poor results. Thus, the excellent and good rate was 86.4%. One patient had anesthesia in the thenar eminence and this symptom disappeared after 3 months. One patient had delayed healing in the proximal wrist crease. Two patients had mild pain on the ulnar side of the wrist and two patients had limited wrist joint function.

Conclusion:

The MIPO technique by using two small palmar incisions is safe and effective for treatment of distal radial fractures.     

解剖锁定钢板治疗桡骨远端粉碎性骨折

<正>2008年8月~2012年8月,我院采用桡骨远端解剖锁定钢板治疗48例桡骨远端粉碎性骨折患者,获得满意疗效,报道如下。1材料与方法 1.1病例资料本组48例,男34例,女14例,年龄36~70岁。按AO分型:B2型6例,B3型10例,C1型15例,C2型13例,C3型4例。均为新鲜骨折。患者术前均行手法复位失败或难以维持复位,受伤至手术时间3~14 d。1.2手术方法臂丛麻醉。取桡骨远     

Intrafocal pin plate fixation of distal ulna fractures associated with distal radius fractures

Subcapital ulnar fractures in association with distal radius fractures in elderly patients increase instability and pose a treatment challenge. Fixation of the ulnar fracture with traditional implants is difficult due to the subcutaneous location, comminution, and osteoporosis. We describe an intrafocal pin plate that provides fixation by a locking plate on the distal ulna and intramedullary fixation within the shaft. The low profile and percutaneous technique make this device a useful alternative for treatment of subcapital ulna fractures in the elderly.     

Reproducibility of three dimensional digital preoperative planning for the osteosynthesis of distal radius fractures

A three‐dimensional (3D) digital preoperative planning system for the osteosynthesis of distal radius fractures was developed for clinical practice. To assess the usefulness of the 3D planning for osteosynthesis, we evaluated the reproducibility of the reduction shapes and selected implants in the patients with distal radius fractures. Twenty wrists of 20 distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. The 3D preoperative planning was performed prior to each surgery. Four surgeons conducted the surgeries. The surgeons performed the reduction and the placement of the plate while comparing images between the preoperative plan and fluoroscopy. Preoperative planning and postoperative reductions were compared by measuring volar tilt and radial inclination of the 3D images. Intra‐class correlation coefficients (ICCs) of the volar tilt and radial inclination were evaluated. For the implant choices, the ICCs for the screw lengths between the preoperative plan and the actual choices were evaluated. The ICCs were 0.644 (p < 0.01) and 0.625 (p < 0.01) for the volar tilt and radial inclination in the 3D measurements, respectively. The planned size of plate was used in all of the patients. The ICC for the screw length between preoperative planning and actual choice was 0.860 (p < 0.01). Good reproducibility for the reduction shape and excellent reproducibility for the implant choices were achieved using 3D preoperative planning for distal radius fracture. Three‐dimensional digital planning was useful to visualize the reduction process and choose a proper implant for distal radius fractures. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2646–2651, 2017.

     

桡骨远端骨折治疗进展

桡骨远端骨折是临床最常见的骨折[1],其治疗仍存在争议。对这类骨折的处理许多学者强调了解剖复位、稳定的固定及早期关节功能锻炼的重要性[2],如果治疗不当将会产生明显的并发症。以往桡骨远端骨折治疗的主要方     

Results of pronator quadratus repair in distal radius fractures to prevent tendon ruptures

Background:

Distal radius fractures are one of the the most common adult fractures encountered during the clinical practice of an orthopedic surgeon.^1,2 Although several methods of treatment are suggested for these fractures, there are still controversies about the best treatment approach in the literature. Volar plating of distal radius fracture is a method of treatment which has become increasingly popular. One of the complications of this technique is flexor tendon rupture. The purpose of this study was to evaluate the protectiveness of complete repair of pronator quadratus muscle against flexor tendon rupture.

Materials and Methods:

From September 2010 to September 2012, a consecutive series of 157 patients who were younger than 60 years with unstable distal radius fractures were included in the study. A standard volar approach to the distal radius was carried out. The radial and distal ends of pronator quadratus muscle were meticulously elevated from the radius and after volar plate fixation of the fracture, pronator quadratus muscle was restored to its normal insertion. We achieved full coverage of the plate with this muscle and followed the patients postoperatively.

Results:

A total of 135 patients were studied. The mean age of patients was 34 ± 10 years (range 20-60 years). One 55-year-old diabetic female patient with flexor tendon rupture was identified. The flexor pollicis longus tendon had ruptured 16 months after surgery.

Conclusions:

Pronator quadratus repair should be done in distal radius fracture to protect flexor tendons.     

不同方法治疗桡骨远端C型骨折的疗效比较

目的比较应用外固定支架与锁定钢板内固定治疗桡骨远端C型骨折的疗效。方法 48例桡骨远端C型骨折的患者按手术方式不同分为外固定组(采用闭合复位外固定支架,24例)和内固定组(采用切开复位锁定钢板内固定,24例),比较两组患者术中出血量、手术时间、住院时间、骨折愈合时间、术后腕关节功能。结果 48例获得随访,时间6~24(13.19±4.31)个月。术中出血量、手术时间、住院时间、骨折愈合时间外固定组均少(短)于内固定组,差异均有统计学意义(P0.05)。术后影像学在掌倾角、尺偏角:C1型骨折两种治疗方法比较差异无统计学意义(P0.05);C2骨折内固定组优于外固定组,差异有统计学意义(P0.05);C3型骨折外固定组优于内固定组,差异有统计学意义(P0.05)。结论外固定支架与锁定钢板内固定治疗桡骨远端骨折C型骨折均可获得良好的临床疗效。在术后24周影像学比较中:C2型骨折锁定钢板内固定治疗在影像学上有更好的掌倾角和尺偏角,更有利于关节功能恢复;C3型骨折外固定支架具有更好的牵张力,更能有效避免桡骨远端关节面继发性塌陷。外固定支架治疗创伤较小,有利于术后腕关节功能恢复。     

掌侧入路斜T形钢板内固定治疗桡骨远端不稳定骨折

目的探讨掌侧入路斜T形钢板治疗桡骨远端不稳定骨折的临床疗效。方法对25例桡骨远端不稳定骨折采用掌侧入路斜T形钢板内固定并植骨治疗。结果 25例均获得随访,时间6～18个月。X线片显示骨折全部愈合。根据Gartland-Wefley腕关节评分标准进行评估:优18例,良5例,可2例。结论对于桡骨远端不稳定骨折,采用掌侧入路斜T形钢板内固定辅以植骨,既能使骨折复位、固定满意,又有利于术后早期手和腕部的功能康复锻炼,是治疗不稳定性桡骨远端骨折的有效方法。     

Technical tips for (dry) arthroscopic reduction and internal fixation of distal radius fractures

Contrary to general belief, arthroscopic assisted reduction in distal radius fractures can be done in an expeditious manner and with minimal consumption of operating room resources. This article presents the steps for a pleasant arthroscopic experience in detail. The technique proposed combines the benefits of rigid fixation with volar locking plates (for the extra-articular component) and arthroscopic control of the reduction (for the articular component). It is important that the operation be carried out using the dry arthroscopic technique. However, arthroscopy is just an addition to conventional methods. Thorough knowledge of and facility with classic techniques of distal radius fracture treatment is essential for a good result.     

The osteosynthesis of fractures of distal radius with the AO/ASIF Titanium Pi Plate

The AO/ASIF Titanium Pi Plate has been developed for dorsal plating of fractures of the distal radius. It is designed by reflection of the anatomy, to ensure stability of the angle using a juxtaarticular band and to minimize tissue reaction by low profile design. The aim of this study was to evaluate the subjective and objective outcome of 61 consecutively operated patients after a minimum of 12 months (12-29 months) postoperatively. There were 3 A2, 23 A3, 1 B1, 12 C1 and 22 C2 fractures (AO-Classification). The subjective results were good to very good. The range of motion showed over 80% compared to the uninjured side. Overall, there were no ruptures of tendons and 18% irritations. Extension, ulnar abduction and force were significantly better in patients in which the plate has been removed. In this collective the tendon irritations were only 3.8%.With the AO/ASIF Pi Plate good subjective and objective results can be achieved. The indication for removal of the plate should be given generously.     

锁定加压钢板治疗桡骨远端粉碎性骨折

2004年7月～2011年6月,我科应用锁定加压钢板(LCP)治疗27例桡骨远端粉碎性骨折患者,疗效满意。1材料与方法1.1病例资料本组27例(29侧)男12例,女15例,年龄20～75岁。右侧16例,左侧9例,双侧2例。手术时间为伤     

DVR解剖型接骨板结合注射型人工骨治疗桡骨远端不稳定性骨折

<正>2012年3月~2014年1月,我们采用DVR(distal volaris radius)解剖型桡骨远端锁定接骨板治疗38例桡骨远端不稳定性骨折,同时植入注射型人工骨填充骨缺损,术后早期功能锻炼,获得了较好的治疗效果,报道如下。1材料与方法1.1病例资料本组38例,男21例,女17例,年龄28~72岁。按AO分类:B2型4例,B3型7例,C1型11例,C2型9例,C3型7例。     

锁定加压钢板内固定治疗桡骨远端C型骨折

[目的] 探讨锁定加压钢板(LCP)内固定治疗桡骨远端AO分型C型骨折的初期疗效.[方法] 总结从2004年1月-2007年1月应用锁定加压钢板(LCP)内固定治疗桡骨远端C型闭合性骨折37例.手术采用掌侧入路,复位后于掌侧置入LCP钢板,在C型臂X线机透视下检查桡骨长度,桡骨关节面,掌倾角,及尺偏角复位情况,满意后置入锁定螺钉,必要时可以在临时固定下,前臂旋前位显露桡骨背侧组织,对于严重骨缺损者应予植骨.术后第1 d开始被动活动腕关节,1周后主动活动,功能锻炼.[结果] 全部获得随访,平均11个月(8～21个月).X线片显示骨折全部Ⅰ期愈合,平均愈合时间为8周,所有病例均无感染、骨不连、钢板松动、腕管综合征、正中神经炎等并发症.按改良的Mcbride腕关节功能评价标准:优25例,良8例,可4例,优良率为89.18%.[结论] 坚强内固 定下早期进行腕关节功能锻炼是治疗粉碎及不稳定桡骨远端骨折的有效措施,使用锁定加压钢板(LCP)内固定治疗桡骨远端C型骨折具有复位满意,固定坚强,可早期进行功能锻炼,关节功能恢复优良等优点.