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

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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.	纪方, 王光超. 桡骨远端骨折及其周围结构损伤的处理. 国际骨科学杂志, 2017, 38(4): 209-212.
3.	梁羽, 何荣富, 钟凤林. 桡骨远端骨折治疗失败的原因分析. 中医正骨, 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.	印飞, 芮永军, 黎逢峰, 等. 关节镜辅助下克氏针结合外固定支架治疗桡骨极远端骨折疗效观察. 中国修复重建外科杂志, 2017, 31(12): 1414-1417.
6.	印飞, 芮永军, 黎逢峰, 等. 腕关节镜辅助下 “分水岭” 万向锁定加压钢板治疗桡骨极远端骨折. 中国临床解剖学杂志, 2017, 35(6): 688-690.
7.	陈君, 曲良, 徐朋, 等. 改良克氏针联合掌侧锁定钢板治疗桡骨极远端骨折. 中国矫形外科杂志, 2019, 27(18): 1719-1721.
8.	曹发奇, 周武, 夏天, 等. 跨关节外固定支架治疗老年 AO 分型 C3 型桡骨远端骨折术后并发症分析. 中华创伤骨科杂志, 2018, 20(11): 960-963.
9.	李志阳, 张新营, 陈永彩, 等. 桡骨远端 C 型骨折掌侧锁定钢板与外固定架的疗效比较. 组织工程与重建外科杂志, 2018, 14(3): 148-151.
10.	祁义民, 粱斌, 王强, 等. 掌侧正中微创入路锁定钢板与外固定支架治疗桡骨远端骨折的疗效比较. 中华创伤杂志, 2018, 34(9): 813-820.
11.	王谦, 周峰, 王秋根. 桡骨远端骨折的治疗进展. 中华肩肘外科电子杂志, 2015, 3(1): 5-8.
12.	黄卫国, 马栋. 掌侧锁定钛板与外固定架治疗 C 型桡骨远端骨折的中期疗效比较. 中华骨科杂志, 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.	黄政基, 姚霁航, 张晓猛, 等. 桡骨远端骨折不同治疗方法的研究进展. 中国老年学杂志, 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, 黄山, 刘昆, 等. 掌侧钢板内固定治疗桡骨远端骨折腕关节功能恢复的影响因素. 创伤外科杂志, 2019, 21(10): 742-745.
20.	印飞, 芮永军, 黎逢峰, 等. AO “分水岭” 万向锁定加压钢板在桡骨极远端骨折治疗中的应用. 中国修复重建外科杂志, 2017, 31(10): 1278-1280.
21.	洪鸿翔, 邓宏健, 袁锟, 等. 万向锁定加压钢板在桡骨极远端骨折中的应用. 中华手外科杂志, 2019, 35(5): 381-382.
22.	樊健, 蒋波, 袁锋, 等. 桡骨极远端骨折的临床特点及治疗策略. 中华外科杂志, 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.	闵捷, 郭雅娣, 廖晓辉, 等. 保留旋前方肌桡骨远端骨折内固定术的解剖学及临床研究. 中华创伤骨科杂志, 2018, 20(5): 376-381.
26.	胡海洋, 巨积辉, 周正虎, 等. 经掌侧入路部分保留旋前方肌锁定接骨板治疗桡骨远端不稳定性骨折. 中华手外科杂志, 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. 纪方, 王光超. 桡骨远端骨折及其周围结构损伤的处理. 国际骨科学杂志, 2017, 38(4): 209-212.
3. 梁羽, 何荣富, 钟凤林. 桡骨远端骨折治疗失败的原因分析. 中医正骨, 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. 印飞, 芮永军, 黎逢峰, 等. 关节镜辅助下克氏针结合外固定支架治疗桡骨极远端骨折疗效观察. 中国修复重建外科杂志, 2017, 31(12): 1414-1417.
6. 印飞, 芮永军, 黎逢峰, 等. 腕关节镜辅助下 “分水岭” 万向锁定加压钢板治疗桡骨极远端骨折. 中国临床解剖学杂志, 2017, 35(6): 688-690.
7. 陈君, 曲良, 徐朋, 等. 改良克氏针联合掌侧锁定钢板治疗桡骨极远端骨折. 中国矫形外科杂志, 2019, 27(18): 1719-1721.
8. 曹发奇, 周武, 夏天, 等. 跨关节外固定支架治疗老年 AO 分型 C3 型桡骨远端骨折术后并发症分析. 中华创伤骨科杂志, 2018, 20(11): 960-963.
9. 李志阳, 张新营, 陈永彩, 等. 桡骨远端 C 型骨折掌侧锁定钢板与外固定架的疗效比较. 组织工程与重建外科杂志, 2018, 14(3): 148-151.
10. 祁义民, 粱斌, 王强, 等. 掌侧正中微创入路锁定钢板与外固定支架治疗桡骨远端骨折的疗效比较. 中华创伤杂志, 2018, 34(9): 813-820.
11. 王谦, 周峰, 王秋根. 桡骨远端骨折的治疗进展. 中华肩肘外科电子杂志, 2015, 3(1): 5-8.
12. 黄卫国, 马栋. 掌侧锁定钛板与外固定架治疗 C 型桡骨远端骨折的中期疗效比较. 中华骨科杂志, 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. 黄政基, 姚霁航, 张晓猛, 等. 桡骨远端骨折不同治疗方法的研究进展. 中国老年学杂志, 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, 黄山, 刘昆, 等. 掌侧钢板内固定治疗桡骨远端骨折腕关节功能恢复的影响因素. 创伤外科杂志, 2019, 21(10): 742-745.
20. 印飞, 芮永军, 黎逢峰, 等. AO “分水岭” 万向锁定加压钢板在桡骨极远端骨折治疗中的应用. 中国修复重建外科杂志, 2017, 31(10): 1278-1280.
21. 洪鸿翔, 邓宏健, 袁锟, 等. 万向锁定加压钢板在桡骨极远端骨折中的应用. 中华手外科杂志, 2019, 35(5): 381-382.
22. 樊健, 蒋波, 袁锋, 等. 桡骨极远端骨折的临床特点及治疗策略. 中华外科杂志, 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. 闵捷, 郭雅娣, 廖晓辉, 等. 保留旋前方肌桡骨远端骨折内固定术的解剖学及临床研究. 中华创伤骨科杂志, 2018, 20(5): 376-381.
26. 胡海洋, 巨积辉, 周正虎, 等. 经掌侧入路部分保留旋前方肌锁定接骨板治疗桡骨远端不稳定性骨折. 中华手外科杂志, 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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