Volar versus dorsal fixed-angle fixation of dorsally unstable extra-articular distal radius fractures: a biomechanic study

PURPOSE: To evaluate and compare the biomechanic rigidity and strength of 3 fixed-angle plates used to treat extra-articular distal radius fractures that are dorsally unstable. Volar fixed-angle plates were compared with a dorsal fixed-angle nail plate. METHODS: Three plate constructs were tested: the dorsal nail plate (DNP), distal volar radius (DVR) plate, and locking compression plate (LCP) volar distal radius plate. With anatomic, third-generation, artificial composite radii, dorsally unstable extra-articular distal radius fracture models were made by cutting a wedge osteotomy with an 8-mm dorsal gap 1 cm from the articular surface. These models were then fixed with the 3 implants by the method recommended by the manufacturer. The proximal radii of each specimen were attached to the base of a materials testing machine with a probe centered at the radial side of the lunate fossa. The specimens were loaded at a constant rate to failure under axial compression. Load and displacement were plotted graphically, and the resulting rigidities and strengths of each plate were assessed statistically. RESULTS: The DVR group had significantly greater stiffness than the LCP group. The DVR group had significantly higher maximum loads than both the DNP and LCP groups. There were no significant differences in yield loads. Both the DNP and DVR groups had significantly less displacement at yield than the LCP group. CONCLUSIONS: These 3 groups had similar yield loads. However, the LCP was less stiff than the DVR and had more displacement at yield than both the DVR and DNP. The yield load of all 3 implants was much higher than previously described loads for active wrist and finger motion.     

Volar versus dorsal locking plates with and without radial styloid locking plates for the fixation of dorsally comminuted distal radius fractures: A biomechanical study in cadavers

PURPOSE: To compare the stability and stiffness of dorsal and volar fixed-angle distal radius constructs in a cadaveric model. METHODS: A locking distal radius system was used in a combination of a dorsal and styloid plate (group 1), a single volar plate (group 2), and a combination of a volar and styloid plate (group 3) configuration. In addition a single volar 3.5-mm steel locking plate was used in group 4. Each construct was tested on 6 fresh-frozen radii with simulated unstable dorsally comminuted extra-articular distal radius fractures. Specimens were tested on a material testing machine with an extensometer and subjected to axial compression fatigue and load-to-failure testing. RESULTS: No construct failed in fatigue testing of 250 N for 5,000 cycles. Two specimens in each group were tested for 20,000 cycles without failure. The plastic deformation in the double-plate groups was lower compared with the single-plate groups, although the difference was not statistically significant. Group 1 had the highest and group 4 the lowest failure load and stiffness, respectively. The differences between group 1 and the other groups, except failure load compared with group 3, were statistically significant. Groups 2 and 3 had a significantly higher load to failure and group 3 had a significantly higher stiffness compared with group 4. CONCLUSIONS: All constructs offer adequate stability with minimal deformation on fatigue testing under physiologic conditions. Dorsal fixed-angle constructs are stiffer and stronger than volar constructs. The addition of a styloid plate to a volar plate did not significantly improve stability in this model of simulated extra-articular dorsal comminution loaded in axial compression.     

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。     

掌侧锁定加压钢板治疗桡骨远端背侧不稳定性骨折

[目的]探讨掌侧入路“T”形锁定加压钢板（T-LCP）治疗桡骨远端背侧不稳定性骨折的初期疗效。[方法]总结2003年9月～2005年11月经掌侧入路T-LCP内固定治疗桡骨远端背侧不稳定性骨折9例。男3例，女6例，年龄52～74岁，平均63．5岁。按AO分类标准：B2型2例，B3型1例，C1型2例，C2型3例，C3型1例，均为闭合性骨折。所有病例均采取掌侧入路，术中不显露背侧组织，骨缺损严重者置入人工骨（Osteoset）。[结果]9例全部获得随访，平均10．7个月（6～17个月）。X线片显示骨折全部Ⅰ期愈合，平均愈合时间为7周。1例骨缺损严重，术中置入人工骨（Osteoset）。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。术后功能康复时间6～29周，平均12．5周。术后第1d开始被动活动腕关节，1周后主动活动，功能锻炼。按改良的Mcbride腕关节功能评价标准：优7例，良1例，可1例，优良率为88．9％。[结论]经掌侧入路T-LCP治疗桡骨远端背侧不稳定骨折，内固定可靠，允许早期功能锻炼，疗效佳。     

掌侧钢板固定治疗不稳定的背侧移位桡骨远端骨折

[目的]初步探讨掌侧钢板（locking compression plate，LCP）固定治疗不稳定、背侧移位桡骨远端骨折的方法及其效果。[方法]回顾性分析掌侧LCP结合克氏针撬拨、植骨等技术治疗不稳定、背侧移位桡骨远端骨折35例，比较研究手术前后掌倾角、尺偏角、桡骨短缩及关节活动范围等，初步评价其临床疗效。[结果]经随访9-24个月（平均17个月），掌倾角、尺偏角、桡骨短缩均获明显改善，腕关节功能按Sarmiento标准评定，优20例、良12例、可2例、差1例。[结论]对不稳定、背侧移位桡骨远端骨折，掌侧LCP是一种安全有效的治疗方法，可有效防止复位丢失、减少结构性植骨、避免肌腱激惹等并发症。     

Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study

PURPOSE: Controversy exists surrounding the effectiveness and complications associated with dorsal plating for distal radius fractures. This study evaluated the functional outcome of dorsal plating for dorsally angulated distal radius fractures at a single institution. METHODS: Thirty patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared with the uninjured side were recorded. The functional outcome was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Gartland and Werley scoring system. RESULTS: The median patient age at surgery was 59 years. The median follow-up period was 18 months. According to the AO classification system, there were 4 type A fractures, 5 type B fractures, and 21 type C fractures. The median preoperative dorsal angulation was 30 degrees, and the median postoperative angulation was -4 degrees volar. Sixteen patients with fractures had an intra-articular step-off or gap, which were all corrected to neutral by the procedure. Seven patients with the fractures showed positive ulnar variance, all corrected to neutral at time of follow-up evaluation. Compared with the contralateral side, the mean extension and flexion were 88% and 81%, respectively; pronation and supination were 89% and 87%, respectively; and grip strength and thumb pinch were 78% and 94%, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 points, and 28 patients had Gartland and Werley scores of good or excellent. No patients needed to have their plates removed, and no extensor tendon rupture was reported. One patient lost reduction, 1 patient needed a tenolysis of the extensor pollicis longus tendon, and 2 patients required the removal of a single metaphyseal screw. CONCLUSIONS: Results from this study show that patients can expect to have 80% of their range of motion and strength after dorsal plating for distal radius fractures. Moreover, 93% of the patients will have good to excellent functional outcomes. Complications from dorsal plating may be caused by the specific plate used, rather than by the technique itself, supporting a dorsal approach for dorsally angulated distal radius fractures.     

T型钢板内固定治疗桡骨远端不稳定性骨折

目的探讨T型钢板治疗桡骨远端不稳定性骨折的疗效。方法对19例桡骨远端不稳定性骨折患者采用T型钢板内固定治疗。结果 18例获得随访（1例失访）,时间6~23个月,骨折均骨性愈合。疗效根据Dienst et al评分系统进行评定：优9例,良7例,一般2例。结论 T型钢板内固定是治疗桡骨远端不稳性骨折较好的方法。     

A biomechanical comparison of fragment-specific fixation and augmented external fixation for intra-articular distal radius fractures

The biomechanical stability of an internal fixation system that uses low-profile modular implants to stabilize individual fracture components was studied in a validated cadaver fracture model that incorporated physiologic muscle forces and wrist motion. Fragment-specific fixation with immediate range of motion was compared with static augmented external fixation in simulated, unstable 3- and 4-part intra-articular distal radius fractures (n = 20). Fixation was applied and specimens were loaded via their major wrist tendons. Because the wrist joint was not constrained in the internal fixation group, full wrist motion occurred during load application in these specimens. A 3-dimensional motion tracking system calculated individual fracture fragment motion in both groups. In the 3-part fracture pattern fragment-specific fixation showed comparable stability to static augmented external fixation despite the full wrist range of motion that occurred during application of load in these specimens. In the 4-part fracture pattern fragment-specific fixation was shown to be significantly more stable when compared with static augmented external fixation in 4 of 6 axes of motion. Our findings confirm the stability of this low-profile plating system and support the consideration of early wrist motion when treating complex, intra-articular distal radius fractures with fragment-specific fixation.     

掌侧锁定钢板治疗桡骨远端骨折

正2014年12月~2016年1月,我科采用掌侧锁定钢板内固定治疗36例桡骨远端骨折患者,取得较好疗效,报道如下。1材料与方法1.1病例资料本组36例,男13例,女23例,年龄25~72岁。骨折按AO分型:C型8例,B型9例,A型19例。左侧13例,右侧23例。伤后至手术时间3~7 d。     

T形锁定加压接骨板治疗桡骨远端骨折

目的探讨T形锁定加压接骨板治疗桡骨远端骨折的临床效果。方法对21例按AO分类为B型和C型的桡骨远端骨折患者,应用T形锁定加压接骨板进行内固定治疗。结果19例获得随访,时间4～10（6.5±1.9）个月。骨折全部愈合,愈合时间6～12（7.4±1.3）周。根据改良Mcbride腕关节功能评价标准：优12例,良5例,差2例。结论采用T形锁定加压接骨板治疗桡骨远端骨折具有固定可靠,尤其对不稳定的骨折患者具有良好的治疗效果,并有利于患肢早期的功能锻炼。     

掌侧锁定钢板结合外支架治疗C型桡骨远端不稳定骨折

目的探讨掌侧锁定钢板结合外支架治疗c型桡骨远端不稳定骨折的临床疗效。方法应用T形或斜T形掌侧锁定钢板及跨腕关节外支架治疗24例c型桡骨远端不稳定骨折患者。结果22例获得随访,时间6～29个月。按Lidstrom评分系统行影像学评价：优12例,良7例,中3例。依据Cooney评分法对腕关节功能进行评价：优17例,良3例,一般2例。无严重并发症发生。结论．对C型桡骨远端骨折应用掌侧锁定钢板结合外支架治疗能够起到坚强固定和早期活动的作用,可较早恢复腕关节功能,临床效果良好。     

有限内固定加外固定支架治疗桡骨远端粉碎性骨折

目的探讨有限内固定加外固定支架治疗桡骨远端粉碎性骨折的临床疗效。方法采用有限内固定加外固定支架治疗桡骨远端粉碎性骨折45例。结果 42例患者获得随访,时间3～36个月。按Lidstrom评分系统行影像学评价:优30例,良7例,中5例,优良率为88.09%;依据Dienst标准评价腕关节功能:优30例,良8例,中4例,优良率为90.47%。无严重并发症发生。结论有限内固定结合外固定支架治疗桡骨远端粉碎性骨折,复位满意,操作简单,固定牢固,疗效满意。     

A biomechanic comparison of an internal radiocarpal-spanning 2.4-mm locking plate and external fixation in a model of distal radius fractures

PURPOSE: To compare the biomechanic stability of distal radius fracture fixation with a new internal radiocarpal-spanning 2.4-mm locking plate, which acts as an internal distal radius fixator, versus a standard distal radius external fixator. The number of locking screws necessary for adequate fracture fixation was also assessed. METHODS: Ten cadaveric specimens were mounted in a loading fixture with cables attached to the 2 flexor and 3 extensor wrist tendons. A 1-cm osteotomy was created to simulate an unstable distal radius fracture. The radiocarpal-spanning locking plate was fixed to the radius and index metacarpal with 4 screws proximally and 4 distally. The specimen was incrementally loaded through the tendons. Motion at the fracture site was determined. Screws were sequentially removed from the construct, the specimen was again incrementally loaded, and fracture motion was measured. The fixation was then changed to an external fixator, and the loading tests were repeated. RESULTS: Fracture fixation with the radiocarpal-spanning 2.4-mm locking plate was significantly more stable with 4 screws proximally and 4 screws distally (4 x 4) and with the 3 x 3 configuration than with the external fixator in both flexion and extension. The 4 x 4 screw configuration was not significantly different from the 3 x 3 screw configuration. The 4 x 4 screw configuration was significantly more stable than the 2 x 2 and 1 x 1 screw configurations in both flexion and extension. All internal fixator configurations and the external fixator showed more fracture displacement at increasingly higher loads. CONCLUSIONS: Fracture fixation with the new internal radiocarpal-spanning 2.4-mm locking plate is more stable than with a standard distal radius external fixator. Only three 2.4-mm locking screws proximally and three 2.4-mm locking screws distally are required for adequate fixation of the locking spanning plate.     

掌侧与背侧钢板固定关节外桡骨远端背侧粉碎性骨折的生物力学研究

目的 探讨掌侧与背侧钢板固定桡骨远端背侧粉碎性骨折时的抗压缩、抗扭转差异性.方法 将12侧新鲜成人尸体桡骨标本制成桡骨远端背侧粉碎性骨折模型,随机分为2个大组,分别进行掌侧与背侧钢板螺钉固定;再将每个大组分为2个亚组,分别进行轴向压缩试验和水平扭转试验.检测指标:轴向压缩强度、轴向压缩刚度、水平扭转强度和水平扭转刚度.结果 在轴向压缩试验中,掌、背侧两组之间轴向压缩强度差异有统计学意义(P＜0.05),背侧组大于掌侧组;在生理压缩载荷下,掌、背侧两组刚度值差异有统计学意义(P＜0.05),背侧组高于掌侧组.在水平扭转试验中,两组水平扭转强度与扭转刚度差异都没有统计学意义,但数据显示,掌侧组都略强于背侧组.结论 在抗压缩方面,两组的压缩强度以及压缩刚度差异均有统计学意义,背侧组要优于掌侧组;而在抗旋转方面,两组的扭转强度与扭转刚度差异均无统计学意义,但掌侧组在数据上均稍大于背侧组.     

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     

掌侧斜T形钢板治疗老年桡骨远端不稳定性骨折

[目的]探讨掌侧斜T形钢板在治疗老年桡骨远端不稳定性骨折的应用及临床治疗效果。[方法]2001年1月~2003年4月使用掌侧斜T形钢板治疗老年桡骨远端不稳定性骨折42例。男18例,女24例;年龄60~75岁,平均65.1岁。按AO分类:A2型4例,A3型7例,B1型5例,B3型3例,C1型9例,C2型11例,C3型3例。28例骨缺损破坏严重,支撑不满意的行人工骨植入恢复局部稳定性。[结果]全部病例得到12~24个月随访,平均18.2个月。X线片检查结果:掌倾角平均3.66°(-7°~10°),尺偏角20.1°(15°~25°),桡骨短缩6例,平均1.59mm(1~5 mm),短缩≥4 mm的2例,关节面分离、移位6例,平均>1 mm(1~4 mm)。平均关节活动度:掌屈58.2°(30°~70°),背伸55.6°(25°~65°),桡偏16.5°(10°~25°),尺偏24.6°(20°~30°),前臂旋前79.2°(60°~90°),旋后70.1°(50°~90°);握力平均为对侧的65%(35%~105%)。根据Sarm iento改良Gartland andW erley评分标准,优25例、良11例、可4例、差2例。[结论]掌侧斜T形钢板治疗老年桡骨远端不稳定骨折是安全有效的治疗选择。可提供稳定的固定,早期功能训练,获得较好的效果,避免背侧固定固有的并发症。充分植骨能有效防止复位丢失。     

掌侧入路锁定加压钢板内固定治疗老年桡骨远端骨质疏松性骨折

目的探讨T形锁定加压钢板治疗老年桡骨远端骨质疏松性骨折的初期疗效。方法总结2003年6月～2005年5月T形锁定加压钢板内固定治疗老年桡骨远端骨质疏松性骨折13例,男4例,女9例;年龄67～81岁,平均74岁。按AO分类标准:B2型2例,B3型3例,C1型2例,C2型5例,C3型1例,均为闭合性骨折。所有病例均采用掌侧入路,术中不显露背侧组织,骨缺损严重者置入人工骨(Osteoset)。术后功能康复时间6～30周,平均12.3周。术后第1天开始被动活动腕关节,1周后主动活动,功能锻炼。结果13例全部获得随访,平均13.2个月(4～22个月)。X线片显示骨折全部一期愈合,平均愈合时间为7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9例,良3例,可1例,优良率为92.3%。结论T形锁定加压钢板治疗老年骨质疏松引起的桡骨远端骨折,内固定牢靠,可以早期功能锻炼,减少了因长期固定而导致的骨量丢失,避免腕关节的僵硬程度,疗效佳。     

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.     

T形钢板内固定治疗桡骨远端不稳定骨折

目的探讨T型钢板内固定治疗桡骨远端骨折的临床疗效。方法对按AO分类为B、C型的28例桡骨远端骨折患者,按A0内固定原则,使用斜“T”形或“T”形钢板行内固定治疗。结果术后随访4～18个月,平均12个月,所有患者均获得骨性愈合,根据术后X线片及改良Shea功能评估标准,优21例,良5例,可2例,优良率为93％。结论“T”形钢板治疗桡骨远端骨折临床疗效满意,尤其对于不稳定型以及骨质疏松性桡骨远端骨折,能够牢固维持术中恢复的解剖形状,有利于患腕早期功能锻炼。