Wrist arthroscopy-assisted titanium internal fixator for the
treatment of complex distal radius fractures

doi:10.3969/j.issn.2095-4344.2410

Abstract

Abstract:

BACKGROUND: Traditional complex of diagnosis and treatment of distal radius fractures, did not get the repair in time and clinical misdiagnosis is not uncommon, become an important reason for the wrist joint pain and dysfunction. Wrist joint complexity assisted treatment of distal radius fractures can more accurately judge complexity of the distal radius fracture damage. The microscopic surgery can protect the blood supply, can also repair intra-articular ligament, cartilage injury, and along with all the dislocation, fracture of carpal bone fixed effectively.

OBJECTIVE: To retrospectively analyze clinical effects of distal radial anatomical locking plate for complex distal radius fractures by joint arthroscopy.

METHODS: Totally 19 patients with complex distal radius fractures, who were treated in the Department of Trauma and Hand Surgery, Sichuan Provincial Orthopedic Hospital from September 2016 to May 2018, were included in this study. According to AO classification, there were B2 type in 1 patient, B3 type in 2 patients, C1 type in 5 patients, C2 type in 7 patients and C3 type in 4 patients. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Open reduction and internal fixation with anatomical locking plate of distal radius assisted by wrist arthroscopy were used to repair the intercarpal interosseous ligaments and triangular fibrocartilage complex, and to fix the wrist fracture. At 1 year after treatment, the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle were compared with the healthy side, and the functional evaluation was conducted with Mayo wrist score.

RESULTS AND CONCLUSION: (1) Nineteen patients received postoperative follow-up. The healing time of distal radius was 5-12 months, with an average of 7 months. (2) At 1 year after surgery, no significant difference was detected in the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle (P > 0.05). (3) The Mayo wrist score was excellent in 9 cases, good in 8 cases, and average in 2 cases, with the excellent and good rate of 90%. (4) Treatment of complex distal radius fractures with distal radial anatomical locking plate by wrist arthroscopy can accurately restore the stability of the joint, and simultaneously repair the fracture with cartilage damage and intra-articular ligament, which is conducive to early functional exercise and has a satisfactory effect.

Key words: distal radius fracture, minimally invasive, arthroscopy, internal fixator, wrist joint, motion range, fracture healing

CLC Number:

R459.9

R318

R687

Yang Shun, Chen Keyi, Cheng Yabo, Xiang Wang, Zhang Jing, Gu Hongji, Chi Haotian. Wrist arthroscopy-assisted titanium internal fixator for the treatment of complex distal radius fractures[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(3): 366-371.

Figures/Tables 4

References

[1] HERBERT TJ, FISHER WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984;1:114-123.
[2] HOVE LM. Simultaneous scaphoid and distal radial fractures. J Hand Surg Br. 1994;3:384-388.
[3] KOMURA S, YOKOI T, NONOMURA H, et al. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am. 2012;3:469-476.
[4] GOLOGAN R, GINTER VM, HAEFFNER A, et al. 1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures. Arch Orthop Trauma Surg. 2016; 136(3):425-432.
[5] ZHANG Q,LIU F,XIAO Z,et al. Internal versus external fixation for the treatment of distal radial fractures:a systematic review of over⁃lapping meta-analyses. Medicine(Baltimore). 2016; 95(9):e2945.
[6] KOMURA S, YOKOI T, NONOMURA H, et al. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am. 2012; 37(3): 469-476.
[7] NARANJE S, KOTWAL PP, SHAMSHERY P, et al. Percutaneous fixation of selected scaphoid fractures by dorsal approach. Int Orthop. 2010;7:997-1003.
[8] KOMURA S, YOKOI T, NONOMURA H, et al. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am. 2012;3:469-476.
[9] ARO HT, KOIVUNEA T. Minor axial shortening of the radius affects Outcome of Colles’ fracturre treatment. Hand Surg(Am). 1991;16:392-398.
[10] GURBUZ Y, SUGUN TS, KAYALAR M. Combined fractures of the scaphoid and distal radius: evaluation of early surgical fixation (21 patients with 22 wrists). J Wrist Surg.2018;1: 11-17.
[11] KHANCHANDANI P, BADIA A. Functional outcome of arthroscopic assisted fixation of distal radius fractures. Indian J Orthop. 2013; 47(3): 288-294.
[12] ONO H, KATAYAMA T, FURUTA K,et al. Distal radial fracture arthroscopic intra-articular gap and step-off measurement after open reduction and internal fixation with a volar locked plate. Orthop Sci. 2012;17(4):443-449.
[13] 陈宏,滕晓峰,李学渊.关节镜辅助治疗桡骨远端关节内骨折[J]. 中华手外科杂志, 2009,25(3):145-146.
[14] 刘照华,王大平,刘黎军,等.钢板预置关节镜复位技术(Part)治疗桡骨远端骨折[J]. 中国骨与关节损伤杂志, 2012,27(9): 807-809.
[15] 陈国奋,土井一辉,顾立强.桡骨远端关节内骨折的分类与关节镜下复位固定[J].中华创伤骨科杂志,2004,6(10):1167-1170.
[16] VERSTREKEN F, MEERMANS G. Transtrapezial approach for fixation of acute scaphoid fractures: rationale, surgical techniques, and results: aaos exhibit selection. J Bone Joint Surg Am. 2015;10:850-858.
[17] MCQUEEN MM, GELBKE MK, WAKEFIELD A, et al. Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study. J Bone Joint Surg Br. 2008;1:66-71.
[18] ABU AE, SEITEL A, RASOULIAN A, et al. Bone enhancement in ultrasound using local spectrum variations for guiding percutaneous scaphoid fracture fixation procedures. Int J Comput Assist Radiol Surg. 2015;6:959-969.
[19] JURKOWITSCH J,DALL'ARA E,QUADLBAUER S,et al. Rotational stability in screw-fixed scaphoid fractures compared to plate-fixed scaphoid fractures. Arch Orthop Trauma Surg. 2016;136(11):1623-1628.
[20] KARANTANA A, DOWNING ND, FORWARD DP, et al. Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods:a randomized controlled trial. J Bone Joint Surg Am. 2013; 95(19):1737-1744.
[21] 瞿利锋,余学中.全腕关节置换术进展[J].国外医学骨科学册, 2005,26(4):217-220.
[22] IACOBELLIS C, BALDAN S, ALDEGHERI R. Percutaneous screw fixation for scaphoid fractures. Musculoskelet Surg. 2011;3:199-203.
[23] 王华松,黄继锋,蔡贤华,等.经皮Herbert螺钉内固定治疗腕舟骨骨折[J].中国骨与关节损伤杂志,2013,28(3):286-287.
[24] 陈山林,荣艳波,张宁,等.介绍一种新的前臂损伤“三联征”[J]. 中华手外科杂志,2016,32(1):32-34.
[25] GARCIA RM, RUCH DS. Management of scaphoid fractures in the athlete: open and percutaneous fixation. Sports Med Arthrosc. 2014;22(1): 22-28.
[26] 王东昕,韩鑫,李志德,等.影响桡骨远端骨折有限切开复位外固定架联合克氏针固定术后功能恢复的相关因素分析[J].中国矫形外科杂志,2017,25(2):97-101.
[27] LINDAU T, HAGBERG L, ADLERCREUTZ C, et al. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res. 2000;376(376): 229-235.
[28] ARAF M, MATTAR JUNIOR R. Arthroscopic study of injuries in articular fractures of distal radius extremity. Acta Ortop Bras. 2014; 22(3):144-150.
[29] GEISSLER WB, FREELAND AE, SAVOIE FH,et al. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. Bone Joint Surg Am. 1996;78(3):357-365.
[30] OGAWA T, TANAKA T, YANAI T, et al. Analysis of soft tissue injuries associated with distal radius fractures. BMC Sports Sci Med Rehabil. 2013; 5:19.
[31] DUNCAN SF, WEILAND AJ. Minimally invasive reduction and osteosynthesis of articular fractures of the distal radius. Injury. 2001;32(1):14-24.
[32] 赵亮,汤泽博,苏佳灿.桡骨远端骨折研究进展[J].中国骨伤,2010, 23(8):638-640.
[33] VARITIMIDIS SE, BASDEKIS GK, DAILIANA ZH, et al. Treatment of intraarticular fractures of the distal radius: Fluoroscopic or arthroscopic reduction? Bone Joint Surg. 2008;90B:778-785.
[34] DOI K, HATTORI Y, OTSUKA K, et al. Intraarticular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. Bone Joint Surg Am. 1999,81:1093-1110.