The outcomes of volar locking plating for intraarticular distal radius fractures

Öz

Objective: We aimed to evaluate the functional and radiological results of intraarticular distal radius fractures which treated with volar locking plates. Methods: Twenty-eight patient (mean age 44.6; range 19-74) with intraarticular distal radius fracture were treated with volar locking plate. Of these 18 were type B, and 10 were type C. Mean follow-up was 19 months. Patients were evaluated with MAYO score, and DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Shortening, radial inclination and palmar tilt were recorded. Uninjured wrist was used for comparison. Results: Union was achieved in all fractures. MAYO score revealed excellent results in 6 patients, good in 7 patients, satisfactory in 14 patients, and poor in 1 patients at the latest follow-up. The mean postoperative DASH score was 16.4 (range, 0-76). The mean radial inclination loss was 0.9 degrees and mean palmar tilt loss was 6.9 degrees when compared to uninjured wrist. Active flexion was 56.3°, extension was 52.5°, supination was 74.2° and pronation was 70.7°. Extensor tenosynovitis was observed in four patients, fleksor pollisis longus tenosynovitis in two, carpal tunnel syndrome in two, superficial infection in one, sudeck atrophy in one. Conclusion: Volar locking plates maintain adequate stability with satisfactory functional results in the treatment of intraarticular distal radius fractures. However, flexor and extensor tendon problems, entrapment of median nerve and reflex sympathetic dystrophy should be kept in mind which might be encountered. In case of tenosynivitis, if union had been achieved the implants should be removed without delay.

Anahtar Kelimeler

• Distal radius fracture, internal fixation, volar locking plate, function.

Eklem içi distal radius kırıklarının volar kilitli plakla tedavi sonuçları

Öz

Amaç: Çalışmamızda eklem içi distal radius kırıklarında volar kilitli plakla tespitin fonksiyonel ve radyolojik sonuçlarının değerlendirilmesi amaçlandı. Yöntemler: Eklem içi distal radius kırığı tanısıyla volar kilitli plakla tedavi edilen 28 hasta (ort. yaş 44.6; dağılım 19-74) çalışmaya alındı. Kırıklar AO/ASIF sınıflamasına göre sınıflandırıldı. Buna göre 18 hasta B ve 10 hasta C tipi kırık idi. Ortalama takip süresi 19 ay (dağılım 12-28) idi. Hastalar MAYO el bileği skoru ve DASH (Disabilities of the Arm, Shoulder and Hand) anketi ile değerlendirildi. Radyolojik incelemede radial kısalma, radial ve palmar eğimler ölçüldü. Klinik ve radyolojik karşılaştırma için sağlam el bileği kullanıldı. Bulgular: Tüm kırıklarda kaynama elde edildi. Ameliyat sonrası MAYO skorlamasında 6 hastada mükemmel, 7 hastada iyi, 14 hastada yeterli ve bir hastada kötü sonuç alındı. Ortalama DASH skoru 16.4 (dağılım 0-76) olarak bulundu. Sağlam tarafla karşılaştırıldığında radial eğimde ortalama 0.9 derecelik ve palmar eğimde ortalama 6.9 derecelik kayıp saptandı. Ortalama aktif fleksiyon 56.3°, ekstansiyon 52.5°, supinasyon 74.2° ve pronasyon 70.7° ölçüldü. Dört hastada ekstansör tendon tenosinoviti, iki hastada fleksör pollisis longus tenosinoviti, iki hastada karpal tünel sendromu, bir hastada yüzeyel enfeksiyon ve bir hastada refleks sempatik distrofi görüldü. Sonuçlar: Volar kilitli plaklar, eklem içi distal radius kırıklarının tedavisinde yeterli tespit ve tatmin edici fonksiyonel sonuçlar sağlamaktadır. Bununla birlikte, fleksör ve ekstansör tendon sorunları, median sinir tuzaklanması ve refleks sempatik distrofi ile karşılaşılabileceği akılda tutulmalıdır. Tenosinovit semptomlarının gözlendiği olgularda, kaynama sağlanmışsa vakit kaybetmeksizin implantlar çıkarılmalıdır.

Anahtar Kelimeler

• Distal radius kırığı, internal tespit, volar kilitli plak, fonksiyon.

Kaynakça

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