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Winkelstabile Plattenosteosynthese am distalen Radius

Assoziiert eine Osteoporose schlechtere funktionelle Ergebnisse und höhere Komplikationsraten?

Volar locking plating for distal radial fractures

Is osteoporosis associated with poorer functional results and higher complications rates?

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Zusammenfassung

Hintergrund

Diese prospektive Studie erfasst die funktionellen und radiologischen Ergebnisse sowie Komplikationen nach volarer winkelstabiler Plattenosteosynthese am distalen Radius bei älteren Patienten in Abhängigkeit vom Osteoporosegrad. Die Hypothese, dass eine verminderte Knochendichte mit schlechteren Ergebnissen und höheren Komplikationsraten einhergeht, soll geprüft werden.

Patienten und Methoden

Insgesamt 65 konsekutive Patienten mit instabiler distaler Radiusfraktur, AO-23-A2 (n=1), -A3 (n=29), -C1 (n=2), -C2 (n=28), -C3 (n=5), im medianen Alter von 69 (52–86) Jahren wurden 6 Wochen, 3 und 12 Monate postoperativ klinisch und radiologisch nachuntersucht. Alle Patienten erhielten innerhalb von 6 Wochen postoperativ eine Knochendichtemessung am kontralateralen distalen Radius. Danach wurden 3 Gruppen differenziert: Gruppe I (n=27): Osteoporose, Gruppe II (n=27): Osteopenie und Gruppe III (n=11): normale Knochendichte. Neben dem DASH- und QAL-Score wurden das Bewegungsausmaß, die Handkraft sowie die radiologischen Parameter erfasst. In Abhängigkeit vom Osteoporosegrad erfolgte eine detaillierte Komplikationsanalyse.

Ergebnisse

Exemplarisch werden hier die 12-Monats-Ergebnisse im DASH und das Bewegungsausmaß aufgeführt: Der DASH-Score betrug 12 Monate postoperativ: DASHgesamt=6 (0–64) P., DASHGruppe I=7 (0–32,5) P., DASHGruppe II=11 (1–63) P., DASHGruppe III=2 (0–23) P.; nicht signifikant. In allen 3 Gruppen steigerte sich das Bewegungsausmaß (außer die Pronation in Gruppe I und III) von 6 Wochen auf 3 und 12 Monate postoperativ und betrug 12 Monate postoperativ im Gesamtkollektiv median: Dorsalextension 55° (25–75), Palmarflexion 55° (35–75), Ulnarabduktion 35° (20–45), Radialabduktion 20° (5–40), Supination 90° (60–90), Pronation 85° (65–90) ohne signifikanten Unterschied zwischen allen 3 Gruppen. Die gruppenspezifische Komplikationsanalyse der implantat- und knochenqualitätsbedingten Komplikationen ergab 2/27 (7%) sekundäre intraartikuläre Schraubenperforationen in Gruppe I, 1/27 (4%) in Gruppe II und 0/11 in Gruppe III.

Schlussfolgerung

Die Hypothese, dass eine verminderte Knochendichte zu signifikant schlechteren Ergebnissen führt, bestätigte sich nicht. Die Komplikationsanalyse zeigte tendenziell mehr knochenqualitätsbedingte Komplikationen in der Osteoporosegruppe.

Abstract

Background

The purpose of this prospective study was to compare the functional and radiological results and complication rates after locking plate osteosynthesis of unstable distal radial fractures in elderly patients as a function of the bone mineral density (BMD). The hypothesis that reduced BMD is accompanied by poorer function and a higher rate of complications was investigated.

Patients and Methods

A total of 65 consecutive patients with unstable distal radial fractures, AO 23-A2 (n=1), -A3 (n=29), -C1 (n=2), -C2 (n=28) and -C3 (n=5) were included with a mean age of 69 years (range, 52–86 years). Standardized clinical and radiological follow-up was performed 6 weeks, 3 and 12 months postoperatively. All patients underwent dual x-ray absorptiometry of the contralateral distal radius within 6 weeks postoperatively and 3 groups could be differentiated: group I (n=27) osteoporosis, group II (n=27) osteopenia and group III (n=11) normal BMD. Data on the DASH and QAL scores as well as the range of motion, grip strength and radiological parameters were collected. According to the BMD a detailed analysis of complications was performed.

Results

Exemplary the 12 months results of DASH and the range of motion are shown here: the DASH 12 months postoperatively was DASHtotal=6 (0–64) P, DASHgroup I=7 (0–32.5) P, DASHgroup II=11 (1–63) P, DASHgroup III=2 (0–23) P, no significance. The range of motion increased significantly in all 3 groups (except pronation in groups I and III) from 6 weeks to 3 and 12 months postoperatively and 12 months postoperatively showed means for dorsal extension 55° (25–75), palmar flexion 55° (35–75), ulnar abduction 35° (20–45), radial abduction 20° (5–40), supination 90° (60–90) and pronation 85° (65–90) in the total sample. The comparison of DASH and range of motion was not significantly different at each time of follow-up between all 3 groups. A group-specific analysis of implant and BMD dependent complications showed 2/27 (7%) secondary intra-articular screw perforations in group I, 1/27 (4%) in group II and 0/11 in group III.

Conclusion

The hypothesis that a reduced BMD is accompanied by a poorer function and a higher rate of complications was refuted. Analysis of complications showed a trend to more BMD-dependent complications in the osteoporosis group.

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  1. Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland

    C. Voigt, A. Plesz, G. Jensen, C. Katthagen & H. Lill

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  1. C. Voigt
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  2. A. Plesz
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  3. G. Jensen
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  4. C. Katthagen
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Correspondence to C. Voigt.

Additional information

Diese Studie wurde von der AO Foundation, AO Clinical Investigation and Documentation, Davos, Schweiz unterstützt.

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Voigt, C., Plesz, A., Jensen, G. et al. Winkelstabile Plattenosteosynthese am distalen Radius. Chirurg 83, 463–471 (2012). https://doi.org/10.1007/s00104-011-2153-1

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