Abstract
Purpose to evaluate and to compare radiological and functional outcomes of the volar locking plate fixation using pronator-sparing approach and K-wire fixation of distal radius fractures. Materials and Methods. We retrospectively analyzed 41 patients with distal radius fractures (27 female and 14 male) treated in the period from 2016 to 2020 using minimally invasive osteosynthesis via pronator-sparing approach. The mean age was 51 years (31-74 years). The control group consists of 37 patients (19 female and 18 male, mean age 61 years (29-76 years)), who underwent minimally invasive percutaneous K-wire fixation of distal radius fractures during the same period of time. Comparative analysis of radiographic and functional outcomes in both groups of minimally invasive osteosynthesis of distal radius fractures was carried out in the period from 1 to 6 months after the surgery. Results. Primary union of distal radius fractures was confirmed in X-rays in all patients within 6 weeks after the surgery. There were no complications in patients treated by pronator-sparing volar locking plate fixation, whereas in K-wire group we had 6 patients with complications: 4 cases (11%) superficial infection around K-wires and 2 cases (5,4%) intraoperative damage of sensitive branch of radial nerve. There were statistically significant differences in radiographic results (volar tilt, radial inclination, and radial height) between two groups: they all were better in patients treated by pronator-sparing volar locking plate fixation during the whole follow-up period (р0,01). Minimally invasive volar locking plate fixation via pronator-sparing approach also provided significantly better grip strength and range of wrist motion and forearm rotation in the early 6-month postoperative period, compared with percutaneous K-wire fixation (р0,001). Conclusion. Our study demonstrates that both techniques of minimally invasive osteosynthesis of distal radius fractures are effective and relatively safe methods of surgical treatment, but volar plating via pronator-sparing approach leads to a better reconstruction of the distal radius and better functional outcomes compared to percutaneous K-wiring.
Highlights
Все оперативные вмешательства в обеих группах проводили одной бригадой хирургов в условиях периферической блокады плечевого сплетения надключичным или подмышечным доступом под контролем ультразвуковой навигации
Costa M.L., Achten J., Plant C., Parsons N.R., Rangan A., Tubeuf S. et al UK DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius
Summary
Критерии включения в исследование: – согласие пациента; – острая изолированная травма; – закрытый характер перелома; – переломы типов I и III по классификации D.L. Fernandez с соавторами [19]; – удовлетворительные результаты первичной закрытой ручной репозиции; – нестабильный характер перелома ДМЛК по М. Всем пострадавшим был выполнен малоинвазивный остеосинтез ДМЛК. Для классификации повреждения и выбора оптимальной тактики лечения переломов ДМЛК всем пациентам выполняли рентгенографию лучезапястного сустава в двух проекциях, а также компьютерную томографию. У 24 пациентов был диагностирован перелом типа I (30,8%), у 17 — типа III (21,8%). Вторую (контрольную) группу составили 37 пациентов: 18 мужчин и 19 женщин, возраст больных варьировал от 29 до 76 лет (медиана 61). У 26 пациентов был диаг ностирован перелом типа I (33,3%), у 11 — типа III (14,1%)
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