Operative Orthopadie und Traumatologie · 2016
[Arthroscopically assisted osteosynthesis of intraarticular distal radius fractures].
Клиническое исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Lutz M, Erhart S, Deml C, Klestil T
Аннотация
OBJECTIVE: Anatomical reconstruction of the distal radius after intra-articular fractures with special consideration of the articular surface and treatment of concomitant ligament injuries.
INDICATIONS: Intra-articular distal radius fractures in adults under 65 years of age.
CONTRAINDICATIONS: Osteoporotic deterioration of metaphyseal bone, radiocarpal fracture dislocation and open fractures.
SURGICAL TECHNIQUE: Conventional palmar approach for plate fixation of the fracture with a fixed angle locking plate. Arthroscopy of the wrist is performed for reduction of the articular fracture component using the standard 3‑4 and 6R portals. Following temporary Kirschner (K) wire fixation of the fracture, angle stable locking screws are inserted into the most distal portion of the plate. Finally, the intercarpal ligaments and the triangular fibrocartilage complex (TFCC) are checked for concomitant lesions and if necessary subsequent treatment within the same operation.
POSTOPERATIVE MANAGEMENT: Plaster cast fixation for 4 weeks followed by a physiotherapy program.
RESULTS: After arthroscopically assisted reduction of an intra-articular distal radius fracture, 17 out of the 23 patients were available for follow-up examination an average of 31 months after the procedure. The mean disabilities of the arm, shoulder and hand (DASH) score was 4.9 and the mean patient-rated wrist evaluation (PRWE) score was 6.0 at final follow-up. Except for wrist flexion, an active range of motion at the wrist as well as forearm rotation of more than 90 % was achieved compared with the uninjured contralateral side. Grip strength averaged 96 % compared with the contralateral side and pain levels under stress varied between 1 and 3 on a visual analog scale (range 0-10).
INDICATIONS: Intra-articular distal radius fractures in adults under 65 years of age.
CONTRAINDICATIONS: Osteoporotic deterioration of metaphyseal bone, radiocarpal fracture dislocation and open fractures.
SURGICAL TECHNIQUE: Conventional palmar approach for plate fixation of the fracture with a fixed angle locking plate. Arthroscopy of the wrist is performed for reduction of the articular fracture component using the standard 3‑4 and 6R portals. Following temporary Kirschner (K) wire fixation of the fracture, angle stable locking screws are inserted into the most distal portion of the plate. Finally, the intercarpal ligaments and the triangular fibrocartilage complex (TFCC) are checked for concomitant lesions and if necessary subsequent treatment within the same operation.
POSTOPERATIVE MANAGEMENT: Plaster cast fixation for 4 weeks followed by a physiotherapy program.
RESULTS: After arthroscopically assisted reduction of an intra-articular distal radius fracture, 17 out of the 23 patients were available for follow-up examination an average of 31 months after the procedure. The mean disabilities of the arm, shoulder and hand (DASH) score was 4.9 and the mean patient-rated wrist evaluation (PRWE) score was 6.0 at final follow-up. Except for wrist flexion, an active range of motion at the wrist as well as forearm rotation of more than 90 % was achieved compared with the uninjured contralateral side. Grip strength averaged 96 % compared with the contralateral side and pain levels under stress varied between 1 and 3 on a visual analog scale (range 0-10).