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Erste Ergebnisse der multidirektional-winkelstabilen palmaren Osteosynthese der distalen Radiusfraktur

First results with a multidirectional fixed angle implant for internal fixation of distal radius fractures

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Zusammenfassung

Fragestellung

Bislang erhältliche winkelstabile Systeme am distalen Radius waren durch fest vorgegebene Verblockungsstellungen limitiert. Neuentwickelte multidirektionale winkelstabile Systeme am distalen Radius wurden entwickelt, um das extraartikuläre Einbringen der Schrauben zu ermöglichen und durch die Variabilität der Plattenlöcher eine zentrale und dorsale Abstützung der Gelenkfläche zu erreichen.

Methodik

In einer prospektiven Untersuchung wurden konsekutiv 20 Patienten mit Radiusextensionsfrakturen über einen standardisierten palmaren Zugang mit einem multidirektional über sphärische Keilverblockung des Schraubenkopfs winkelstabilen Implantat (APTUS/Medartis, Basel) unter Armplexusanästhesie versorgt. Die Patienten wurden bislang über 26 (23–28 Wochen) u. a. hinsichtlich Schmerz (visuelle Analogskala [VAS] 0–100), Funktion, Griffkraft, Krimmer-Score, DASH-Score (DASH Disability of the Hand, Shoulder and Arms) und radiologisch untersucht. Zudem wurden die Operateure bzgl. der Handhabung des Instrumentariums befragt. Als statistische Methoden wurden der χ2-Test sowie ANOVA in Verbindung mit dem Tukey-post-hoc-Test eingesetzt. Signifikanz wurde für p <0,05 angenommen.

Ergebnisse

Es wurde ein durchschnittlicher Bewegungsumfang für Extension/Flexion von 87° (76% der Gegenseite) und Ulnar-/Radialduktion von 42° (88%) erreicht. Die Patienten waren schmerzfrei bzw. schmerzarm (VAS 3 ohne, 24 unter Belastung). Die grobe Griffkraft betrug 84% der Gegenseite. Insgesamt mit der Behandlung zufrieden waren 82% der Patienten. Der durchschnittliche DASH-Score betrug 13. Im Krimmer-Score fand sich mit durchschnittlich 83±27 Punkten ein exzellentes Ergebnis. Die radiologisch dargestellte Ulnavarianz betrug 0,9±0,4 mm, die Radioulnarinklination 21±5° und die Palmarinklination 4±6°.

Schlussfolgerung

Unsere Daten zeigen, dass das Versorgungskonzept mit multidirektional winkelstabiler Osteosynthese am distalem Radius zuverlässig und effektiv ist. Jedoch sind prospektive Vergleiche mit den anderen etablierten Verfahren erforderlich, um den definitiven Stellenwert zu bestimmen.

Abstract

Background

The management of fractures of the distal radius continues to evolve. New operative strategies have recently been developed including the use of fixed-angle plates. This study reviews the results of 20 patients with fractures of the distal radius treated with a new multidirectional fixed angle plate.

Method and materials

A total of 20 patients with closed Colles type fractures of the distal radius were treated with Medartis (Aptus 2.5) palmar fixed-angle plates. Surgery was performed under plexus anesthesia using the standard or extended flexor carpi radialis (FCR) approach. Patients were evaluated prospectively with a mean follow-up of 26 weeks (range 23–28 weeks). Pain, range of motion, grip strength, DASH score, modified Mayo wrist score and radiographs were obtained. The level of significance was set at 95% and the χ2 and ANOVA tests in combination with a post hoc Tukey test were used for statistical analysis.

Results

The average range of motion (ROM) in extension-flexion was 87° (76% of the contralateral side) and in ulnar-radial deviation 42° (88% of the contralateral side). Pain values (visual analogue scale 0–100) at follow-up were 3 (without stress) and 24 (with stress). Grip strength improved to 84% of the contralateral side, the mean DASH score was 13 points and the modified Mayo wrist score confirmed the excellent results with a mean value of 83±27 points. Radiological examination showed a satisfactory result with an ulna variance of 0.9±0.4 mm, radio-ulnar inclination of 21±5° and palmar inclination of 4±6°.

Conclusions

Our data show that treating unstable distal radius fractures with multidirectional palmar fixed-angle plates is reliable and effective and produces good early functional and radiological results. However, long-term results with a larger number of patients and randomized prospective studies comparing this technique with other established procedures are required.

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  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Deutschland

    R. Meier, C. Krettek & C. Probst

  2. Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    R. Meier

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  1. R. Meier
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Correspondence to R. Meier.

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Meier, R., Krettek, C. & Probst, C. Erste Ergebnisse der multidirektional-winkelstabilen palmaren Osteosynthese der distalen Radiusfraktur. Unfallchirurg 113, 789–795 (2010). https://doi.org/10.1007/s00113-010-1845-1

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