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Die palmare winkelstabile Plattenosteosynthese bei distaler Radiusfraktur

Vorteile und Nachteile

The palmar fixed angle plate in distal radius fractures – advantages and disadvantages

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Abstract

In operations of palmar dislocated distal radius fractures, the palmar locking plate has already proved itself early. The principle of “angle stability” works as an internal fixator and a stable support of the joint area makes it possible without danger of secondary dislocation. This is an advantage particularly for older patients with poor bone quality.

However, with the palmar locking plate there are also limits and the indication has to be evaluated individually. The correct placement of the screws is particularly important. An intraarticular placement of the screws is described in1–3% of the cases. Special intraoperative X-rays can protect against this.

A rupture of the EPL tendon is described in 0–3% of cases. A2, A3, C1 and C2 fractures according to the AO classification are favorable for this method. Here the fracture line can be reconstructed anatomically and the joint fragments supported sufficiently by the plate. More distally placed palmar fragments can further be held with multidirectionally locking plates. With the C3 fracture (AO) the palmar locking plate is pushed to its limits. Defect replenishment or even many different osteosyntheses are also frequently necessary here.

Zusammenfassung

Bei Operation der palmar dislozierten distalen Radiusfraktur hat sich die palmare Plattenosteosynthese schon früh bewährt. Das Prinzip der „Winkelstabilität“ wirkt wie ein Fixateur interne und ermöglicht so von Anfang an eine stabile Abstützung der Gelenkfläche ohne Gefahr der sekundären Dislokation. Dies ist besonders für ältere Patienten mit schlechter Knochenqualität von Vorteil.

Auch bei der palmaren winkelstabilen Platte gibt es Grenzen und muss deren Indikation individuell gestellt werden. Besonders wichtig ist die korrekte Platzierung der Schrauben. Eine intraartikuläre Fehlplatzierung ist in immerhin 1–3% der Fälle beschrieben und kann durch intraoperative spezielle Röntgenkontrolle vermieden werden. Eine daraus resultierende Ruptur der EPL-Sehne wird in 0–3% beschrieben. In der Literatur werden als für dieses Verfahren günstige Frakturen die A2, A3, C1, C2-Frakturen nach AO mit ausreichend großem metaphysären Fragment angesehen. Hier können die Frakturlinie durch die Platte überbrückt und die Gelenkfragmente ausreichend abgestützt werden. Weiter distale palmare Fragmente können mit multidirektionalen winkelstabilen Platten gut gefasst werden. Bei der C3-Fraktur stößt die palmare winkelstabile Platte an ihre Grenzen. Häufig wird hier zusätzlich eine Defektauffüllung oder sogar eine Mehrfachosteosynthese notwendig.

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Authors and Affiliations

  1. Bereich für Hand- und Mikrochirurgie Stiftung, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany

    N. Schmelzer-Schmied,  A. K. Martini &  M. Jung

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  1. N. Schmelzer-Schmied
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  2. A. K. Martini
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  3. M. Jung
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Correspondence to N. Schmelzer-Schmied.

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Schmelzer-Schmied, N., Martini, A.K. & Jung, M. Die palmare winkelstabile Plattenosteosynthese bei distaler Radiusfraktur. Obere Extremität 2, 150–155 (2007). https://doi.org/10.1007/s11678-007-0048-z

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  • DOI: https://doi.org/10.1007/s11678-007-0048-z

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