ObjectiveTo investigate the effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults.MethodsThe clinical data of 62 cases of unstable distal radius fractures between January 2017 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative exposure, the patients were divided into the observe group (28 cases with the pronator quadratus muscle sparing surgery) and the control group (32 cases with cutting the pronator quadratus muscle in operation and repairing it after volar plate fixation). There was no significant difference in general data such as gender, age, handedness, cause of injury, fracture classification, time from injury to operation, visual analogue scale (VAS) score, and range of motion (ROM) of wrist (flexion, extension, pronation, and supination) before operation between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time, and postoperative complications were recorded and compared between the two groups. VAS score and ROM of wrist of two groups before operation and at 3 days and 3 months after operation were calculated and compared. The wrist function was evaluated according to the Krimmer evaluation criteria at 6 months after operation.ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). The postoperative hospital stay and fracture healing time of the observe group were significantly shorter than those of the control group (P<0.05). Patients in both groups were followed up 6-30 months, with an average of 13 months. The VAS score and ROM of wrist of the observe group at 3 days after operation were superior to the control group (P<0.05), but there was no significant difference between the two groups at 3 months after operation (P>0.05). At 6 months after operation, according to Krimmer evaluation criteria, the wrist function of the observe group was excellent in 21 cases and good in 7 cases, with an excellent and good rate of 100%; and the wrist function of the control group was excellent in 22 cases, good in 11 cases, and fair in 1 case, with an excellent and good rate of 97.1%. There was no significant difference in wrist function between the two groups (χ2=1.344, P=0.511). One case of poor incision healing occurred in the observe group, and 7 cases of poor incision healing and 5 cases of tendon pain occurred in the control group after operation. The incidence of postoperative complications was less in the observe group (3.6%) than in the control group (35.3%) (χ2=9.325, P=0.002).ConclusionIt is feasible of the pronator quadratus muscle sparing in the volar plate fixation for unstable distal radius fracture in adults. It is beneficial to recover wrist function early after operation, reduce postoperative complications, shorten the length of hospitalization, protect the soft tissue of fracture site, and promote fracture healing.
Objective To investigate the risk factors for postoperative loss of reduction in unstable distal radius fractures and to develop a predictive model, providing clinicians with a more precise risk assessment tool to support the formulation of individualized treatment plans. MethodsA retrospective analysis was conducted on the clinical data of 209 patients with unstable distal radius fractures who met the selection criteria between January 2018 and December 2023. There were 97 males and 112 females, aged 44-81 years with a mean age of 57.1 years. Univariate analysis was performed to identify factors associated with postoperative loss of reduction. Multivariate logistic regression analysis was then used to screen risk factors and construct a nomogram prediction model. The Hosmer-Lemeshow test was applied to assess model fit, while the area under the receiver operating characteristic (ROC) curve (AUC) was calculated to evaluate the predictive performance. Additionally, decision curve analysis was employed to assess the clinical utility of the model. ResultsAt 6 months after operation, radiographic evaluation showed loss of reduction in 68 cases. Univariate analysis identified the following as influencing factors for postoperative loss of reduction (P<0.05): age, fracture displacement, fracture classification, dorsal metaphyseal comminuted fracture, osteoporosis, operation time, and preoperative serum calcium level. Multivariate analysis confirmed the following as risk factors for postoperative loss of reduction (P<0.05): older age, more severe fracture type (higher AO/OTA classification), presence of fracture displacement, dorsal metaphyseal comminuted fracture, low preoperative serum calcium level, osteoporosis, and prolonged operation time. The nomogram prediction model constructed based on these factors demonstrated high accuracy in assessing the risk of loss of reduction, with an AUC of 0.946 (95%CI: 0.917, 0.975). The calibration curve showed good agreement between predicted and observed probabilities (χ2=4.735, P=0.785). Decision curve analysis indicated that when the predicted risk of postoperative loss of reduction exceeds 0.1, timely intervention can yield substantial net clinical benefit. ConclusionOlder age, AO/OTA type C fractures, fracture displacement, dorsal metaphyseal comminuted fracture, prolonged operation time, low preoperative serum calcium level, and comorbid osteoporosis are the main risk factors for postoperative loss of reduction in patients with unstable distal radius fractures. The established predictive nomogram model enables clinicians to more accurately assess the risk of postoperative loss of reduction and provides valuable support for personalized treatment decisions.
