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Volare winkelstabile vs. dorsale Plattenosteosynthese bei der distalen Radiusextensionsfraktur

Eine prospektive, randomisierte Untersuchung

Volar locking compression plating versus dorsal plating for fractures of the distal radius

A prospective, randomized study

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Zusammenfassung

Fragestellung

In der Studie wurden radiologisches und funktionelles Outcome zweier unterschiedlicher Versorgungskonzepte bei der distalen Radiusextensionsfraktur untersucht.

Methodik

In einer kontrollierten, randomisierten Studie wurden Patienten mit einer Radiusfraktur prospektiv erfasst und volare gegen dorsale Versorgung verglichen. Randomisiert wurde nach Alter, Dominanz (Händigkeit) und Frakturklassifikation.

Ergebnisse

Es wurden 120 Patienten prospektiv in der Studie erfasst. Das Durchschnittsalter lag bei 66 Jahren. Bei 49% handelte es sich um Typ-A- und bei 51% um Typ-C-Frakturen. An perioperativen Komplikationen zeigten sich bei der Gruppe der volaren Plattenosteosynthesen 6 operationspflichtige Karpaltunnelsyndrome und 1 Strecksehnen (EPL)-Ruptur. Bei den dorsalen Osteosynthesen waren 3 Re-Operationen notwendig: 1 EPL-Ruptur, 1 Plattenbettinfekt und 1 Plattendislokation. Die radiologischen Ergebnisse im Stewart-1-Score zeigten bei der volaren Platte in 68% sehr gute Ergebnisse gegenüber 57% bei den dorsalen. Funktionell waren nach dem Stewart-2-Score 48% der volaren Platten sehr gut, gegenüber 22% bei den dorsalen.

Schlussfolgerung

Obwohl sich messbare, signifikante Vorteile bei den volaren winkelstabilen Platten zeigten, besteht kein Unterschied bei der subjektiven Zufriedenheit zwischen den beiden Gruppen.

Abstract

Introduction

This study investigated the radiographic and functional outcomes of two different methods for treating fractures of the distal part of the radius.

Patients and methods

In a prospective controlled study patients with forearm fractures were randomized by age, handedness, and fracture type.

Results

The study included 120 patients, with a mean age of 66 years. Forty-nine percent of the fractures were extraarticular, and 51% were intraarticular. In the group treated with volar locking compression plates, six patients needed operative decompression of the median nerve and one needed reconstruction of the extensor pollicis longus (EPL) tendon. The group with dorsal plating had three complications requiring operative treatment: one deep infection, one dislocation of the plate, and one reconstruction of the EPL tendon. The radiological results for the Stewart 1 score showed 68% excellent results in volar locking compression plating compared with 57% in dorsal plating. Regarding functional outcome, 48% with volar plating showed excellent results compared with 22% with dorsal plating, as measured by the Stewart 2 score.

Conclusion

Despite significant advantages of the volar locked compression plating, subjective satisfaction did not differ between the two groups.

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Literatur

  1. Arora R, Lutz M, Fritz D et al (2005) Palmar locking plate for treatment of unstable dorsal dislocated distal radius fractures. Arch Orthop Trauma Surg 125:399–404

    Article  PubMed  CAS  Google Scholar 

  2. Arora R, Lutz M, Hennerbichler A et al (2007) Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 21:316–322

    Article  PubMed  Google Scholar 

  3. Arora R, Lutz M, Zimmermann R et al (2007) Limits of palmar locking-plate osteosynthesis of unstable distal radius fractures. Handchir Mikrochir Plast Chir 39:34–41

    Article  PubMed  CAS  Google Scholar 

  4. Chung KC, Watt AJ, Kotsis SV et al (2006) Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am 88:2687–2694

    Article  PubMed  Google Scholar 

  5. Dumont C, Fuchs M, Folwaczny EK et al (2003) Results of palmar T-plate osteosynthesis in unstable fractures of the distal radius. Chirurg 74:827–833

    Article  PubMed  CAS  Google Scholar 

  6. Felderhoff J, Wiemer P, Dronsella J et al (1999) The operative therapy of distal unstable radius fractures with dorsal and palmar plates. A retrospective study with respect to the DASH-score system. Orthopade 28:853–863

    PubMed  CAS  Google Scholar 

  7. Gabl M (2007) Distal radius fracture. Handchir Mikrochir Plast Chir 39:1

    Article  PubMed  CAS  Google Scholar 

  8. Gartland JJ Jr,Werley CW (1951) Evaluation of healed colles‘ fractures. J Bone Joint Surg Am 33:895–907

    PubMed  Google Scholar 

  9. Kamano M, Honda Y, Kazuki K et al (2002) Palmar plating for dorsally displaced fractures of the distal radius. Clin Orthop Relat Res 397:403–408

    Article  PubMed  Google Scholar 

  10. Krimmer H, Pessenlehner C, Hasselbacher K et al (2004) Palmar fixed angle plating systems for instable distal radius fractures. Unfallchirurg 107:460–467

    Article  PubMed  CAS  Google Scholar 

  11. Lutz M, Arora R, Smekal V et al (2007) Long-term results following ORIF of dorsal dislocated distal intraarticular radius fractures. Handchir Mikrochir Plast Chir 39:54–59

    Article  PubMed  CAS  Google Scholar 

  12. Musgrave DS, Idler RS (2005) Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg [Am] 30:743–749

    Google Scholar 

  13. Orbay J (2005) Volar plate fixation of distal radius fractures. Hand Clin 21:347–354

    Article  PubMed  Google Scholar 

  14. Orbay JL, Fernandez DL (2004) Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg [Am] 29:96–102

    Google Scholar 

  15. Orbay JL,Touhami A (2006) Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res 445:58–67

    PubMed  Google Scholar 

  16. Papadonikolakis A, Ruch DS (2005) Internal distraction plating of distal radius fractures. Tech Hand Up Extrem Surg 9:2–6

    Article  PubMed  Google Scholar 

  17. Pechlaner S (1993) Distal intra-articular radius fractures. Indications for and technique of open reduction and plate osteosynthesis. Orthopade 22:46–51

    PubMed  CAS  Google Scholar 

  18. Pechlaner S, Gabl M, Lutz M et al (2007) Distal radius fractures-aetiology, treatment and outcome. Handchir Mikrochir Plast Chir 39:19–28

    Article  PubMed  CAS  Google Scholar 

  19. Ring D, Jupiter JB (2005) Treatment of osteoporotic distal radius fractures. Osteoporos Int 16(Suppl 2):80–84

    Article  Google Scholar 

  20. Rozental TD, Blazar PE (2006) Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg [Am] 31:359–365

    Google Scholar 

  21. Sakhaii M, Groenewold U, Klonz A et al (2003) Results after palmar plate-osteosynthesis with angularly stable T-plate in 100 distal radius fractures: a prospective study. Unfallchirurg 106:272–280

    Article  PubMed  CAS  Google Scholar 

  22. Siebert HR, Klonz A (2006) Fracture of the distal radius. Chirurg 77:545–562

    Article  PubMed  CAS  Google Scholar 

  23. Stewart HD, Innes AR, Burke FD (1985) Factors affecting the outcome of Colles’ fractures: an anatomical and functional study. Injury 16:289–295

    Article  PubMed  CAS  Google Scholar 

  24. Trease C, McIff T, Toby EB (2005) Locking versus nonlocking T-plates for dorsal and volar fixation of dorsally comminuted distal radius fractures: a biomechanical study. J Hand Surg [Am] 30:756–763

    Google Scholar 

  25. Voigt C, Lill H (2006) What advantages does volar plate fixation have over K-wire fixation for distal radius extension fractures in the elderly? Unfallchirurg 109:845–846, 848–854

    Article  PubMed  CAS  Google Scholar 

  26. Wiemer P, Koster G, Felderhoff J et al (1999) Fractures of the distal radius. Changing therapeutic strategies. Orthopade 28:846–852

    PubMed  CAS  Google Scholar 

  27. Zettl RP, Ruchholtz S, Taeger G et al (2001) Postoperative morbidity in surgically treated extension fractures of the distal radius. A comparative study of dorsal and volar approach. Unfallchirurg 104:710–715

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Giessen und Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    R.P. Zettl, S. Ruchholtz & C.A. Kühne

  2. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Essen, Deutschland

    R.P. Zettl, E. Clauberg, D. Nast-Kolb, S. Ruchholtz & C.A. Kühne

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  1. R.P. Zettl
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  2. E. Clauberg
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  3. D. Nast-Kolb
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  4. S. Ruchholtz
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  5. C.A. Kühne
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Correspondence to R.P. Zettl.

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Zettl, R., Clauberg, E., Nast-Kolb, D. et al. Volare winkelstabile vs. dorsale Plattenosteosynthese bei der distalen Radiusextensionsfraktur. Unfallchirurg 112, 712–718 (2009). https://doi.org/10.1007/s00113-008-1526-5

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  • DOI: https://doi.org/10.1007/s00113-008-1526-5

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