Die palmare winkelstabile Plattenosteosynthese bei distalen Radiusextensionsfrakturen

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Goniometrically Stable Palmar Osteosynthesis with Plates in Distal Radius Fractures. Of a total of 398 extension fractures of the distal radius, 322 were surgically treated between January 1996 and December 1999 at the hospital for accident, hand and rehabilitation surgery of the Erfurt clinic. Following good experiences with a palmar implantation of a conventional T plate of 3.5 mm radius in A3 and C1 fractures we conducted a prospective study to find out whether a goniometrically stable implant would be suitable also for stabilising instabilities of a higher degree. We compared the 71 patients with goniometrically stable osteosynthesis operated on between 1/1998 and 12/1999 (group A) with a group B of 98 patients who had been treated with a conventional T plate between 1/1996 and 12/ 1997. According to the AO classification, group A comprised 28 A3 fractures, 16 C1 fractures, 17 C2 fractures and 10 C3 fractures, whereas in group B there were 49 A3 fractures, 26 C1 fractures, 14 C2 fractures and 9 C3 fractures. The age and gender distributions being comparable, group A had a higher percentage of C2 and C3 fractures. Following early functional testing of group A patients (usually after the second postoperative day) and functional training of group B patients after the 14th postoperative day, both patient groups were clinically examined at the earliest 6 months after osteosynthesis. The functional result was assessed at follow-up time, using a scoring system according to Cooney and Bussey (50% subjective, 50% objective). The x-ray results were analysed according to a scoring system of the AO working group distal radius (100% subjective). It was established with high significance (p<0.001) that group A yielded better functional and x-ray results, based on statistical evaluation by the chi-square test. Classification according to functional criteria yielded in group A 58% very good patient ratings and 28% good ratings, whereas in group B the ratings were 24% very good and 36% good. X-ray criteria results were rated successful in 68% of group A and in 31 % of group B patients. The verdict tolerable was assigned to 32% of group A and 59% % of group B patients, whereas in group A there was not a single patient with unsatisfactory x-ray findings. In particular, we could no longer detect any deficient dorsoaxial correction due to the goniometrically stable implant in cases of high-grade instability. Over and above this we also managed to cut down the in-patient treatment time by 1.1 days and the total treatment time by 2.9 weeks. Complications in group B were two wound infections and 10 noticeable dorsoaxial correction deficits which resulted in reostosynthesis in 6 cases (complication rate 12%). The complication rate in group A was 7% consisting of one postoperative carpal tunnel syndrome and four deficiently implanted goniometrically stable screws, these complications being noticed at the beginning of the series. There was no reflex dystrophia in any of the 169 patients.