Clinical effects of locking plate system in treating distal radial fractures

Abstract

OBJECTIVE: To determine the clinical results of locking plate system in the treatment of distal radial fractures. METHODS: From May 2004 to November 2006, 75 patients were treated with 2.4 mm locking plate system. There were 41 males and 34 females, with a mean age of 51 years old (range, 13-82 years old). The locations were left side in 34 cases and right side in 41 cases. The cause of injury was a low energy fall in 49 cases, falling from height in 14 cases, traffic accident in 6 cases and sports injuries in 6 cases. All patients were diagnosed as having closed fracture. According to Müller-AO classification, there were 14 cases(18.7%) of type A, 5 cases(6.7%) of type B, and 56 cases(74.6%) of type C. The time from injury to operation was 5 hours to 27 days (mean 6 days). RESULTS: A total of 75 patients were followed up at 3 months, 71 patients at 6 months, 68 patients at 1 year and 51 patients at 2 years. Healing by first intention of incision was achieved in 73 cases, and infection occurred in 2 cases. Fracture reduction failed at 1 month, 3 months and 6 months in 1 case, respectively; 1 case received plaster fixation and 2 cases received re-fixation and autograft of ilium; and fracture healed in 3 cases at last follow-up. Two patients complained of skin numbness at site of superficial branch of radial nerve after 1 day, 1 patient had wound pain after operation, and 1 patient had infection of tendon at 3 days and 5 days in 1 case respectively. At last follow-up, the ranges of motion of wrist joint were (80 +/- 9) degrees for pronation, (86 +/- 7) degrees for supination, (57 +/- 10) degrees for dorsal flexion, (51 +/- 13) degrees for palmar flexion, (18 +/- 7) degrees for radial inclination, and (28 +/- 7) degrees for ulnar deviation. According to modified Green scoring, the results were excellent in 66 cases, good in 6 cases and poor in 3 cases. At last follow-up, according to Knirk criterion for osteoarthritis, there were 22 cases of grade I and 5 cases of grade II, and all were classified as type C. CONCLUSION: Internal fixation of distal radial fractures with 2.4 mm locking plate system provided a stable fixation with good clinical outcomes.

目的探討采用2.4mm帶鎖鋼板固定系統治療橈骨遠端骨折的療效。方法2004年5月-2006年11月,采用切開復位、2.4mm帶鎖鋼板固定系統內固定治療75例橈骨遠端骨折。男41例,女34例;年齡13～82歲,平均51歲。左側34例,右側41例。損傷原因:摔傷49例,高處墜落傷14例,交通事故傷6例,運動傷6例。均為閉合性骨折。橈骨遠端骨折根據Müller-AO分型:A型14例(18.7%),B型5例(6.7%),C型56例(74.6%)。受傷至手術時間5h～27d,平均6d。結果術后3、6個月,1、2年分別有75、71、68及51例患者獲隨訪。術后73例切口Ⅰ期愈合,2例發生感染,換藥后3、6周愈合。1例術中螺釘植于軟骨下,術后第2天調整螺釘位置,術后1、3及6個月各1例復位失敗,其中1例予石膏外固定,2例行再固定及自體髂骨植骨,末次隨訪時骨折均愈合;術后1d2例訴橈神經淺支分布區域皮膚麻木,口服營養神經藥物后分別于術后5d和3個月癥狀消失,1例術后持續傷口疼痛,術后半年疼痛自行緩解;術后3、5d各1例發生肌腱感染,經保守治療后3、6周治愈。末次隨訪時腕關節活動范圍:旋前(80±9)°,旋后(86±7)°,背屈(57±10)°,掌屈(51±13)°,橈偏(18±7)°,尺偏(28±7)°。根據改良Green等評分標準,獲優66例,良6例,差3例。末次隨訪時根據Knirk等標準,22例(29.3%)有1級骨性關節炎改變,5例(6.7%)有2級骨性關節炎改變,均為C型骨折患者。結論采用2.4mm帶鎖鋼板固定系統治療橈骨遠端骨折,臨床效果良好。