Effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in treatment of extreme distal radius fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAO Xiaoke ¹ , WU Lingna ² , LI Jianhua ¹ , HUANG Wengang ¹ , WANG Chongwen ¹ , GU Zuchao ¹ ,  WANG Yue ³

1. Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China;
2. Intensive Care Unit, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China;
3. Department of Orthopedics, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, Chengdu Sichuan, 610072, P.R.China;

Corresponding?author：

WANG Yue, Email: wang669yue@163.com

Keywords：

Extreme distal radius fracture; oblique T-type locking plate; open reduction; internal fixation

DOI：

10.7507/1002-1892.201911108

Video：

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Objective To investigate the effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in the treatment of extreme distal radius fractures.Methods Between July 2014 and July 2018, 15 patients with extreme distal radius fractures were treated with volar oblique T-type locking plate and raft screws reduction and fixation. There were 6 males and 9 females, aged from 30 to 66 years with an average age of 56.6 years. The cause of injury was falling from height in 2 cases and falling in 13 cases. All of them were fresh closed injuries. The fractures were rated as type 23C1 in 8 cases and as type 23C2 in 7 cases according to AO/Orthopaedic Trauma Association (AO/OTA) classification. There were 7 cases of ulnar styloid process fracture and 2 cases of distal radioulnar joint instability. The time from injury to operation was 6 to 9 days with an average of 7.3 days. The fracture healing and the radial height, palm inclination, and ulnar deviation were observed by X-ray reexamination. Cooney score was used to evaluate the effectiveness.Results All incisions healed by first intention. All patients were followed up 12-24 months, with an average of 14.6 months. X-ray films showed that all fractures healed, and the healing time ranged from 5 to 10 months, with an average of 8.2 months. No internal fixation failure or secondary fracture displacement occurred. At last follow-up, the radial height, palm inclination, and ulnar deviation recovered well, and the differences between pre- and post-operation were significant (P<0.05). The pain, function, activity, and grip strength scores and the total score of Cooney score were significantly higher than those before operation (P<0.05). There were 11 cases of excellent, 3 cases of good, and 1 case of good, with an excellent and good rate of 93%.Conclusion For extreme distal radius fractures, the volar oblique T-type locking plate and raft screws reduction and fixation can restore the radialheight, palm inclination, and ulnar deviation, fix firmly, and recover the wrist joint function exercise early, and obtain satisfactory effectiveness.

Citation： YAO Xiaoke, WU Lingna, LI Jianhua, HUANG Wengang, WANG Chongwen, GU Zuchao, WANG Yue. Effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in treatment of extreme distal radius fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 809-813. doi: 10.7507/1002-1892.201911108 Copy

1.	Orbay JL, Touhami A. Current concepts in volar fixed-anger flxation of unstable distal radius fractures. Clin Orthop Relat Res, 2006, (455): 58-67.
2.	紀方, 王光超. 橈骨遠端骨折及其周圍結構損傷的處理. 國際骨科學雜志, 2017, 38(4): 209-212.
3.	梁羽, 何榮富, 鐘鳳林. 橈骨遠端骨折治療失敗的原因分析. 中醫正骨, 2018, 30(2): 50-53, 58.
4.	Jose A, Suranigi SM, Deniese PN, et al. Unstable distal radius fractures treated by volar locking anatomical plates. J Clin Diagn Res, 2017, 11(1): R4-R8.
5.	印飛, 芮永軍, 黎逢峰, 等. 關節鏡輔助下克氏針結合外固定支架治療橈骨極遠端骨折療效觀察. 中國修復重建外科雜志, 2017, 31(12): 1414-1417.
6.	印飛, 芮永軍, 黎逢峰, 等. 腕關節鏡輔助下 “分水嶺” 萬向鎖定加壓鋼板治療橈骨極遠端骨折. 中國臨床解剖學雜志, 2017, 35(6): 688-690.
7.	陳君, 曲良, 徐朋, 等. 改良克氏針聯合掌側鎖定鋼板治療橈骨極遠端骨折. 中國矯形外科雜志, 2019, 27(18): 1719-1721.
8.	曹發奇, 周武, 夏天, 等. 跨關節外固定支架治療老年 AO 分型 C3 型橈骨遠端骨折術后并發癥分析. 中華創傷骨科雜志, 2018, 20(11): 960-963.
9.	李志陽, 張新營, 陳永彩, 等. 橈骨遠端 C 型骨折掌側鎖定鋼板與外固定架的療效比較. 組織工程與重建外科雜志, 2018, 14(3): 148-151.
10.	祁義民, 粱斌, 王強, 等. 掌側正中微創入路鎖定鋼板與外固定支架治療橈骨遠端骨折的療效比較. 中華創傷雜志, 2018, 34(9): 813-820.
11.	王謙, 周峰, 王秋根. 橈骨遠端骨折的治療進展. 中華肩肘外科電子雜志, 2015, 3(1): 5-8.
12.	黃衛國, 馬棟. 掌側鎖定鈦板與外固定架治療 C 型橈骨遠端骨折的中期療效比較. 中華骨科雜志, 2015, 35(7): 734-740.
13.	May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg (Am), 2002, 27(6): 965-971.
14.	Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg (Br), 1996, 78(4): 588-592.
15.	Iselin LD, Massy-Budmiger AS, Droeser RA, et al. Ten years’ follow-up on combined palmar and dorsal internal fixation of complex distal radius fractures. Medicine (Baltimore), 2016, 95(18): e3509.
16.	黃政基, 姚霽航, 張曉猛, 等. 橈骨遠端骨折不同治療方法的研究進展. 中國老年學雜志, 2018, 38(9): 2292-2295.
17.	Cowie J, Anakwe R, Mcqueen M. Factors associated with one-year outcome after distal radial fracture treatment. J Orthop Surg (Hong Kong), 2015, 23(1): 24-28.
18.	Bini A, Surace MF, Pilato G. Complex articular fractures of the distal radius: the role of closed reduction and external fixation. J Hand Surg Eur Vol, 2008, 33(3): 305-310.
19.	王瑞, 黃山, 劉昆, 等. 掌側鋼板內固定治療橈骨遠端骨折腕關節功能恢復的影響因素. 創傷外科雜志, 2019, 21(10): 742-745.
20.	印飛, 芮永軍, 黎逢峰, 等. AO “分水嶺” 萬向鎖定加壓鋼板在橈骨極遠端骨折治療中的應用. 中國修復重建外科雜志, 2017, 31(10): 1278-1280.
21.	洪鴻翔, 鄧宏健, 袁錕, 等. 萬向鎖定加壓鋼板在橈骨極遠端骨折中的應用. 中華手外科雜志, 2019, 35(5): 381-382.
22.	樊健, 蔣波, 袁鋒, 等. 橈骨極遠端骨折的臨床特點及治療策略. 中華外科雜志, 2016, 54(10): 766-771.
23.	Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg (Am), 2004, 29(1): 96-102.
24.	Fujitani R, Omokawa S, Akahane M, et al. Predictors of distal radioulnar joint instability in distal radius fractures. J Hand Surg (Am), 2011, 36(12): 1919-1925.
25.	閔捷, 郭雅娣, 廖曉輝, 等. 保留旋前方肌橈骨遠端骨折內固定術的解剖學及臨床研究. 中華創傷骨科雜志, 2018, 20(5): 376-381.
26.	胡海洋, 巨積輝, 周正虎, 等. 經掌側入路部分保留旋前方肌鎖定接骨板治療橈骨遠端不穩定性骨折. 中華手外科雜志, 2018, 34(3): 181-184.

1. Orbay JL, Touhami A. Current concepts in volar fixed-anger flxation of unstable distal radius fractures. Clin Orthop Relat Res, 2006, (455): 58-67.
2. 紀方, 王光超. 橈骨遠端骨折及其周圍結構損傷的處理. 國際骨科學雜志, 2017, 38(4): 209-212.
3. 梁羽, 何榮富, 鐘鳳林. 橈骨遠端骨折治療失敗的原因分析. 中醫正骨, 2018, 30(2): 50-53, 58.
4. Jose A, Suranigi SM, Deniese PN, et al. Unstable distal radius fractures treated by volar locking anatomical plates. J Clin Diagn Res, 2017, 11(1): R4-R8.
5. 印飛, 芮永軍, 黎逢峰, 等. 關節鏡輔助下克氏針結合外固定支架治療橈骨極遠端骨折療效觀察. 中國修復重建外科雜志, 2017, 31(12): 1414-1417.
6. 印飛, 芮永軍, 黎逢峰, 等. 腕關節鏡輔助下 “分水嶺” 萬向鎖定加壓鋼板治療橈骨極遠端骨折. 中國臨床解剖學雜志, 2017, 35(6): 688-690.
7. 陳君, 曲良, 徐朋, 等. 改良克氏針聯合掌側鎖定鋼板治療橈骨極遠端骨折. 中國矯形外科雜志, 2019, 27(18): 1719-1721.
8. 曹發奇, 周武, 夏天, 等. 跨關節外固定支架治療老年 AO 分型 C3 型橈骨遠端骨折術后并發癥分析. 中華創傷骨科雜志, 2018, 20(11): 960-963.
9. 李志陽, 張新營, 陳永彩, 等. 橈骨遠端 C 型骨折掌側鎖定鋼板與外固定架的療效比較. 組織工程與重建外科雜志, 2018, 14(3): 148-151.
10. 祁義民, 粱斌, 王強, 等. 掌側正中微創入路鎖定鋼板與外固定支架治療橈骨遠端骨折的療效比較. 中華創傷雜志, 2018, 34(9): 813-820.
11. 王謙, 周峰, 王秋根. 橈骨遠端骨折的治療進展. 中華肩肘外科電子雜志, 2015, 3(1): 5-8.
12. 黃衛國, 馬棟. 掌側鎖定鈦板與外固定架治療 C 型橈骨遠端骨折的中期療效比較. 中華骨科雜志, 2015, 35(7): 734-740.
13. May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg (Am), 2002, 27(6): 965-971.
14. Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg (Br), 1996, 78(4): 588-592.
15. Iselin LD, Massy-Budmiger AS, Droeser RA, et al. Ten years’ follow-up on combined palmar and dorsal internal fixation of complex distal radius fractures. Medicine (Baltimore), 2016, 95(18): e3509.
16. 黃政基, 姚霽航, 張曉猛, 等. 橈骨遠端骨折不同治療方法的研究進展. 中國老年學雜志, 2018, 38(9): 2292-2295.
17. Cowie J, Anakwe R, Mcqueen M. Factors associated with one-year outcome after distal radial fracture treatment. J Orthop Surg (Hong Kong), 2015, 23(1): 24-28.
18. Bini A, Surace MF, Pilato G. Complex articular fractures of the distal radius: the role of closed reduction and external fixation. J Hand Surg Eur Vol, 2008, 33(3): 305-310.
19. 王瑞, 黃山, 劉昆, 等. 掌側鋼板內固定治療橈骨遠端骨折腕關節功能恢復的影響因素. 創傷外科雜志, 2019, 21(10): 742-745.
20. 印飛, 芮永軍, 黎逢峰, 等. AO “分水嶺” 萬向鎖定加壓鋼板在橈骨極遠端骨折治療中的應用. 中國修復重建外科雜志, 2017, 31(10): 1278-1280.
21. 洪鴻翔, 鄧宏健, 袁錕, 等. 萬向鎖定加壓鋼板在橈骨極遠端骨折中的應用. 中華手外科雜志, 2019, 35(5): 381-382.
22. 樊健, 蔣波, 袁鋒, 等. 橈骨極遠端骨折的臨床特點及治療策略. 中華外科雜志, 2016, 54(10): 766-771.
23. Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg (Am), 2004, 29(1): 96-102.
24. Fujitani R, Omokawa S, Akahane M, et al. Predictors of distal radioulnar joint instability in distal radius fractures. J Hand Surg (Am), 2011, 36(12): 1919-1925.
25. 閔捷, 郭雅娣, 廖曉輝, 等. 保留旋前方肌橈骨遠端骨折內固定術的解剖學及臨床研究. 中華創傷骨科雜志, 2018, 20(5): 376-381.
26. 胡海洋, 巨積輝, 周正虎, 等. 經掌側入路部分保留旋前方肌鎖定接骨板治療橈骨遠端不穩定性骨折. 中華手外科雜志, 2018, 34(3): 181-184.

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Effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in treatment of extreme distal radius fractures

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