Is arthroscopic intervention-assisted fragment-specific fixation technique superior to volar plating in distal radius fractures involving the middle column?
Öz
Purpose: In this study, the clinical and radiological results of volar plating and arthroscopic intervention-assisted fragment-specific fixation techniques used in patients operated for AO Type B-C distal radius fracture in which the medial colon is affected were compared.
Materials and Methods: X-ray and clinical records of 98 patients who underwent surgical treatment for radius distal end (DER) fracture between April 2011 and January 2017. The patient groups treated with arthroscopy-assisted fragment-oriented fixation (Group A) and plate screw fixation with a volar approach without arthroscopic intervention (Group B) were compared in terms of joint range of motion, grip strength, and clinical scores. Flexion and extension, ulnar deviation, radial deviation, pronation, and supination angles measured with a standard goniometer were recorded in the joint range of motion measurement. Grip strength was measured with a Jamar dynamometer for power measurement. DASH score was used in clinical evaluation.
Results: When the operated wrists of both patient groups were compared, there was no significant difference between the DASH score, grip strength, palmar flexion, and pronation angles of motion. A statistically significant difference was observed between the mean dorsiflexion angles of 55 degrees in group A and 44 degrees in group B, mean radial deviation angles of 25 and 19 degrees, and the mean supination angles of 87 and 80 degrees, respectively.
Conclusion: Although arthroscopic-assisted fragment-specific fixation is technically a laborious procedure that requires a learning curve in patients with intra-articular distal radius fractures, it may be beneficial to provide better postoperative results, especially in young patients with high range of motion expectations.
Anahtar Kelimeler
Distal radius fracture Wrist arthroscopy fragment specific fixation volar plating
Kaynakça
- Helmerhorst GT, Kloen P. Orthogonal plating of intra-articular distal radius fractures with an associated radial column fracture via a single volar approach. Injury. 2012 Aug;43(8):1307-12. doi: 10.1016/j.injury.2012.04.022. Epub 2012 May 29. PMID: 22648016.
- Rikli D, Regazzoni P. Distale Radiusfrakturen [Distal radius fractures]. Schweiz Med Wochenschr. 1999 May 22;129(20):776-85. German. PMID: 10413812.
- Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018 Jan;32 Suppl 1:S1-S170. doi: 10.1097/BOT.0000000000001063. PMID: 29256945.
- Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006 Mar;31(3):359-65. doi: 10.1016/j.jhsa.2005.10.010. PMID: 16516728.
- Rhee PC, Medoff RJ, Shin AY. Complex Distal Radius Fractures: An Anatomic Algorithm for Surgical Management. J Am Acad Orthop Surg. 2017 Feb;25(2):77-88. doi: 10.5435/JAAOS-D-15-00525. PMID: 28033150.
- Burnier JS, Herzberg G, Izem Y. Traitement des fractures articulaires du radius distal sous arthroscopie: le but anatomique est-il atteint?. Chirurgie de la Main, 2013, 6.32: 437. doi: 10.1016/j.main.2013.10.031
- Christiaens N, Nedellec G, Guerre E, Guillou J, Demondion X, Fontaine C, Chantelot C. Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: Retrospective study of 40 cases. Hand Surg Rehabil. 2017 Sep;36(4):268-274. doi: 10.1016/j.hansur.2017.03.003. Epub 2017 Apr 25. PMID: 28465199.
- Huish EG Jr, Coury JG, Ibrahim MA, Trzeciak MA. Radiographic Outcomes of Dorsal Distraction Distal Radius Plating for Fractures With Dorsal Marginal Impaction. Hand (N Y). 2018 May;13(3):346-349. doi: 10.1177/1558944717704514. Epub 2017 Apr 12. PMID: 28403633; PMCID: PMC5987982.
- Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986 Jun;68(5):647-59. PMID: 3722221.
- Saab M, Wunenburger PE, Guerre E, Chantelot C, Morel V, Ehlinger M, Bauer T. Does arthroscopic assistance improve reduction in distal articular radius fracture? A retrospective comparative study using a blind CT assessment. Eur J Orthop Surg Traumatol. 2019 Feb;29(2):405-411. doi: 10.1007/s00590-018-2348-y. Epub 2018 Nov 28. PMID: 30488139.
- Abe Y. Plate presetting and arthroscopic reduction technique (PART) for treatment of distal radius fractures. Handchir Mikrochir Plast Chir. 2014 Oct;46(5):278-85. doi: 10.1055/s-0034-1387705. Epub 2014 Oct 7. PMID: 25290270.
- Landgren M, Abramo A, Geijer M, Kopylov P, Tägil M. Fragment-Specific Fixation Versus Volar Locking Plates in Primarily Nonreducible or Secondarily Redisplaced Distal Radius Fractures: A Randomized Controlled Study. J Hand Surg Am. 2017 Mar;42(3):156-165.e1. doi: 10.1016/j.jhsa.2016.12.001. Epub 2017 Jan 11. PMID: 28089163.
- Conforto I, Samir C, Chausse F, Goldstein A, Pereira B, Coudeyre E. Comparison of psychometric properties between the Labin, a new electronic dynamometer, and the Jamar: Preliminary results in healthy subjects. Hand Surg Rehabil. 2019 Oct;38(5):293-297. doi: 10.1016/j.hansur.2019.07.009. Epub 2019 Aug 3. PMID: 31386926.
- Kleinlugtenbelt YV, Krol RG, Bhandari M, Goslings JC, Poolman RW, Scholtes VAB. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res. 2018 Jan;7(1):36-45. doi: 10.1302/2046-3758.71.BJR-2017-0081.R1. PMID: 29330342; PMCID: PMC5805831.
- Cornu A, Amouyel T, Chantelot C, Saab M. Clinical, functional and prognostic results after repair of peripheral lesions of the triangular fibrocartilage complex: a retrospective study of 21 patients. Eur J Orthop Surg Traumatol. 2021 Apr;31(3):557-562. doi: 10.1007/s00590-020-02805-0. Epub 2020 Oct 13. PMID: 33048247.
- Orbay JL, Rubio F, Vernon LL. Prevent Collapse and Salvage Failures of the Volar Rim of the Distal Radius. J Wrist Surg. 2016 Mar;5(1):17-21. doi: 10.1055/s-0035-1570745. Epub 2016 Jan 12. PMID: 26855831; PMCID: PMC4742256.
- Herzberg G, Burnier M, Nakamura T. A New Wrist Clinical Evaluation Score. J Wrist Surg. 2018 Apr;7(2):109-114. doi: 10.1055/s-0037-1607328. Epub 2017 Oct 30. PMID: 29576915; PMCID: PMC5864495.
- Forward DP, Lindau TR, Melsom DS. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am. 2007 Nov;89(11):2334-40. doi: 10.2106/JBJS.F.01537. PMID: 17974874.
- Hohendorff B, Eck M, Mühldorfer M, Fodor S, Schmitt R, Prommersberger KJ. Palmare Handgelenksarthroskopie zur Beurteilung karpaler Begleitläsionen bei der operativen Versorgung distaler intraartikulärer Radiusfrakturen [Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures]. Handchir Mikrochir Plast Chir. 2009 Oct;41(5):295-9. German. doi: 10.1055/s-0029-1238309. Epub 2009 Sep 29. PMID: 19790024.
- Martin DP, Park AG, Jamison D 4th, Jones CM, Ilyas AM. Biomechanical Comparison of Titanium Locking Fragment-Specific and Volar Locking Plates for AO B1 and B2 Fractures of the Distal Radius. J Hand Surg Am. 2019 Dec;44(12):1093.e1-1093.e8. doi: 10.1016/j.jhsa.2019.02.003. Epub 2019 Mar 18. PMID: 30898463.
- Bolmers A, Luiten WE, Doornberg JN, Brouwer KM, Goslings JC, Ring D, Kloen P. A comparison of the long-term outcome of partial articular (AO Type B) and complete articular (AO Type C) distal radius fractures. J Hand Surg Am. 2013 Apr;38(4):753-9. doi: 10.1016/j.jhsa.2012.12.027. Epub 2013 Mar 1. PMID: 23453896.
- Souer JS, Ring D, Jupiter JB, Matschke S, Audige L, Marent-Huber M; AOCID Prospective ORIF Distal Radius Study Group. Comparison of AO Type-B and Type-C volar shearing fractures of the distal part of the radius. J Bone Joint Surg Am. 2009 Nov;91(11):2605-11. doi: 10.2106/JBJS.H.01479. PMID: 19884434.
- Thorninger R, Madsen ML, Wæver D, Borris LC, Rölfing JHD. Complications of volar locking plating of distal radius fractures in 576 patients with 3.2 years follow-up. Injury. 2017 Jun;48(6):1104-1109. doi: 10.1016/j.injury.2017.03.008. Epub 2017 Mar 10. PMID: 28336098.
Orta kolonu ilgilendiren distal radius kırıklarında artroskopik destekli fragman spesifik fiksasyon standart volar plak ile fiksasyona göre üstün müdür?
Öz
Amaç: Bu çalışmada, medial kolonun etkilendiği AO Tip B-C distal radius kırığı nedeniyle ameliyat edilen hastalarda kullanılan volar plaklama ve artroskopik müdahale destekli fragmana özgü tespit tekniklerinin klinik ve radyolojik sonuçlarını karşılaştırıldı.
Gereç ve Yöntem: Nisan 2011 ile Ocak 2017 arasında radius distal uç (DER) kırığı nedeniyle cerrahi tedavi uygulanan 98 hastanın röntgen ve klinik kayıtları geriye dönük analiz edildi. Artroskopi destekli fragmana yönelik tespit ile tedavi edilen(Grup A), artroskopik müdahale olmaksızın volar yaklaşımla plak vida fiksasyonu uygulanan (Grup B) hasta grupları eklem hareket açıklıkları, kavrama güçleri klinik skorlar açısından karşılaştırıldı. Eklem hareket açıklığı ölçümünde standart gonyometre ile ölçülen fleksiyon ve ekstansiyon, ulnar deviasyon, radyal deviasyon, pronasyon, supinasyon açıları kaydedildi. Güç ölçümü için Jamar dinamometre ile kavrama kuvveti ölçüldü. Klinik değerlendirmede DASH skoru kullanıldı.
Bulgular: Her iki hasta grubunun ameliyatlı bilekleri karşılaştırıldığında DASH skoru, kavrama kuvvetleri, palmar fleksiyon ve pronasyon hareket açıları ortalamaları arasında anlamlı fark görülmedi. Sırasıyla A grubunda ortalama 55 derece ve B grubunda ortalama 44 derece ölçülen dorsifleksiyon açıları, 25 ve 19 derece ölçülen ortalama radial deviasyon açıları, 87 ve 80 derece ölçülen ortalama supinasyon açıları arasında istatistiksel olarak anlamlı farklılık gözlendi.
Sonuç: Eklem içi distal radius kırıklı hastalarda, artroskopik yardımlı fragman spesifik fiksasyon teknik olarak, öğrenme eğrisi gerektiren zahmetli bir işlem olmasına rağmen, özellikle genç ve yüksek eklem hareket açıklığı beklentisi olan hastalarda daha iyi postoperatif sonuçlar sağlamak adına faydalı olabilir.
Anahtar Kelimeler
Distal radius kırıkları El bilek artroskopisi Fragman spesifik tespit Volar plaklama
Kaynakça
- Helmerhorst GT, Kloen P. Orthogonal plating of intra-articular distal radius fractures with an associated radial column fracture via a single volar approach. Injury. 2012 Aug;43(8):1307-12. doi: 10.1016/j.injury.2012.04.022. Epub 2012 May 29. PMID: 22648016.
- Rikli D, Regazzoni P. Distale Radiusfrakturen [Distal radius fractures]. Schweiz Med Wochenschr. 1999 May 22;129(20):776-85. German. PMID: 10413812.
- Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018 Jan;32 Suppl 1:S1-S170. doi: 10.1097/BOT.0000000000001063. PMID: 29256945.
- Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006 Mar;31(3):359-65. doi: 10.1016/j.jhsa.2005.10.010. PMID: 16516728.
- Rhee PC, Medoff RJ, Shin AY. Complex Distal Radius Fractures: An Anatomic Algorithm for Surgical Management. J Am Acad Orthop Surg. 2017 Feb;25(2):77-88. doi: 10.5435/JAAOS-D-15-00525. PMID: 28033150.
- Burnier JS, Herzberg G, Izem Y. Traitement des fractures articulaires du radius distal sous arthroscopie: le but anatomique est-il atteint?. Chirurgie de la Main, 2013, 6.32: 437. doi: 10.1016/j.main.2013.10.031
- Christiaens N, Nedellec G, Guerre E, Guillou J, Demondion X, Fontaine C, Chantelot C. Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: Retrospective study of 40 cases. Hand Surg Rehabil. 2017 Sep;36(4):268-274. doi: 10.1016/j.hansur.2017.03.003. Epub 2017 Apr 25. PMID: 28465199.
- Huish EG Jr, Coury JG, Ibrahim MA, Trzeciak MA. Radiographic Outcomes of Dorsal Distraction Distal Radius Plating for Fractures With Dorsal Marginal Impaction. Hand (N Y). 2018 May;13(3):346-349. doi: 10.1177/1558944717704514. Epub 2017 Apr 12. PMID: 28403633; PMCID: PMC5987982.
- Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986 Jun;68(5):647-59. PMID: 3722221.
- Saab M, Wunenburger PE, Guerre E, Chantelot C, Morel V, Ehlinger M, Bauer T. Does arthroscopic assistance improve reduction in distal articular radius fracture? A retrospective comparative study using a blind CT assessment. Eur J Orthop Surg Traumatol. 2019 Feb;29(2):405-411. doi: 10.1007/s00590-018-2348-y. Epub 2018 Nov 28. PMID: 30488139.
- Abe Y. Plate presetting and arthroscopic reduction technique (PART) for treatment of distal radius fractures. Handchir Mikrochir Plast Chir. 2014 Oct;46(5):278-85. doi: 10.1055/s-0034-1387705. Epub 2014 Oct 7. PMID: 25290270.
- Landgren M, Abramo A, Geijer M, Kopylov P, Tägil M. Fragment-Specific Fixation Versus Volar Locking Plates in Primarily Nonreducible or Secondarily Redisplaced Distal Radius Fractures: A Randomized Controlled Study. J Hand Surg Am. 2017 Mar;42(3):156-165.e1. doi: 10.1016/j.jhsa.2016.12.001. Epub 2017 Jan 11. PMID: 28089163.
- Conforto I, Samir C, Chausse F, Goldstein A, Pereira B, Coudeyre E. Comparison of psychometric properties between the Labin, a new electronic dynamometer, and the Jamar: Preliminary results in healthy subjects. Hand Surg Rehabil. 2019 Oct;38(5):293-297. doi: 10.1016/j.hansur.2019.07.009. Epub 2019 Aug 3. PMID: 31386926.
- Kleinlugtenbelt YV, Krol RG, Bhandari M, Goslings JC, Poolman RW, Scholtes VAB. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res. 2018 Jan;7(1):36-45. doi: 10.1302/2046-3758.71.BJR-2017-0081.R1. PMID: 29330342; PMCID: PMC5805831.
- Cornu A, Amouyel T, Chantelot C, Saab M. Clinical, functional and prognostic results after repair of peripheral lesions of the triangular fibrocartilage complex: a retrospective study of 21 patients. Eur J Orthop Surg Traumatol. 2021 Apr;31(3):557-562. doi: 10.1007/s00590-020-02805-0. Epub 2020 Oct 13. PMID: 33048247.
- Orbay JL, Rubio F, Vernon LL. Prevent Collapse and Salvage Failures of the Volar Rim of the Distal Radius. J Wrist Surg. 2016 Mar;5(1):17-21. doi: 10.1055/s-0035-1570745. Epub 2016 Jan 12. PMID: 26855831; PMCID: PMC4742256.
- Herzberg G, Burnier M, Nakamura T. A New Wrist Clinical Evaluation Score. J Wrist Surg. 2018 Apr;7(2):109-114. doi: 10.1055/s-0037-1607328. Epub 2017 Oct 30. PMID: 29576915; PMCID: PMC5864495.
- Forward DP, Lindau TR, Melsom DS. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am. 2007 Nov;89(11):2334-40. doi: 10.2106/JBJS.F.01537. PMID: 17974874.
- Hohendorff B, Eck M, Mühldorfer M, Fodor S, Schmitt R, Prommersberger KJ. Palmare Handgelenksarthroskopie zur Beurteilung karpaler Begleitläsionen bei der operativen Versorgung distaler intraartikulärer Radiusfrakturen [Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures]. Handchir Mikrochir Plast Chir. 2009 Oct;41(5):295-9. German. doi: 10.1055/s-0029-1238309. Epub 2009 Sep 29. PMID: 19790024.
- Martin DP, Park AG, Jamison D 4th, Jones CM, Ilyas AM. Biomechanical Comparison of Titanium Locking Fragment-Specific and Volar Locking Plates for AO B1 and B2 Fractures of the Distal Radius. J Hand Surg Am. 2019 Dec;44(12):1093.e1-1093.e8. doi: 10.1016/j.jhsa.2019.02.003. Epub 2019 Mar 18. PMID: 30898463.
- Bolmers A, Luiten WE, Doornberg JN, Brouwer KM, Goslings JC, Ring D, Kloen P. A comparison of the long-term outcome of partial articular (AO Type B) and complete articular (AO Type C) distal radius fractures. J Hand Surg Am. 2013 Apr;38(4):753-9. doi: 10.1016/j.jhsa.2012.12.027. Epub 2013 Mar 1. PMID: 23453896.
- Souer JS, Ring D, Jupiter JB, Matschke S, Audige L, Marent-Huber M; AOCID Prospective ORIF Distal Radius Study Group. Comparison of AO Type-B and Type-C volar shearing fractures of the distal part of the radius. J Bone Joint Surg Am. 2009 Nov;91(11):2605-11. doi: 10.2106/JBJS.H.01479. PMID: 19884434.
- Thorninger R, Madsen ML, Wæver D, Borris LC, Rölfing JHD. Complications of volar locking plating of distal radius fractures in 576 patients with 3.2 years follow-up. Injury. 2017 Jun;48(6):1104-1109. doi: 10.1016/j.injury.2017.03.008. Epub 2017 Mar 10. PMID: 28336098.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2022 |
| Kabul Tarihi | 1 Ağustos 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 47 Sayı: 3 |
