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Objective:To explore the clinical outcome of internal fixation in the treatment of AO C-type distal radius fracture accompanied with dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet.Methods:A total of 55 patients of AO C-type distal radius fracture accompanied with dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet from July 2017 to July 2022 in Tongji Hospital Affiliated to Tongji University were retrospectively analyzed. In the volar plate group (volar locking plate treatment alone), there were 22 cases, 11 males and 11 females, aged 56.7±10.1 years, 10 C1 type, 7 C2 type and 5 C3 type. There were 15 patients in the volar plate+dorsal plate group (treated with volar locking plate combined with dorsal plate), including 6 males and 9 females, aged 55.7±8.1 years old, 4 C1 type, 5 C2 type and 6 C3 type. In the volar plate+dorsal screw group (treated with volar locking plate combined with dorsal screw), there were 18 cases, 8 males and 10 females, aged 53.5±11.6 years, 7 cases of C1 type, 5 cases of C2 type, and 6 cases of C3 type. The operation time, postoperative radiographic indicators, wrist range of motion (ROM), disability of arm, shoulder and hand (DASH) score, visual analogue scale (VAS) and postoperative complications were evaluated and compared between the three groups.Results:All operations were successfully completed. Patients were followed up for 14.9 ± 2.2 months (range, 12-18 months), and the fracture healing time was 12.4±2.3 weeks (range, 9-16 weeks). The operative time of patients in the volar plate group, volar plate+dorsal plate group and volar plate+dorsal screw group was 54.3±7.6 min, 70.7±5.9 min and 65.8± 7.1 min, respectively. Patients in the volar plate group had less operative time ( F=27.04, P<0.001). The residual displacement of the dorsoulnar fragment in sagittal, coronal, and axial CT scans in the three groups were (1.3±0.8 mm, 0.6±0.4 mm, 0.7±0.4 mm), (1.1±0.8 mm, 0.6±0.4 mm, 0.6±0.6 mm), (1.4±0.8 mm, 0.7±0.4 mm, 0.7±0.5 mm). The displacement of the dorsoulnar fragment of the two groups of combined volar and dorsal internal fixation was smaller than that of the volar plate group ( P<0.05). The ROM of wrist flexion of the three groups at 3 months after operation were 44.2°±4.6°, 47.7°±5.9°, 48.8°±5.1°, the ROM of wrist extension were 39.8°±6.2°, 44.3°± 4.6°, 44.7°±5.1°, the wrist DASH scores were 23.0±4.2, 20.1±4.1 and 19.4±3.0, and the VAS were 2.3±1.2, 1.6±1.3 and 1.3±1.0, respectively. The ROM of wrist flexion and extension and DASH score in volar plate+dorsal plate group were better than those in volar plate group ( P<0.05). The ROM of wrist flexion and extension, DASH score and VAS in the volar plate+dorsal screw group were better than those in the volar plate group ( P<0.05). There were no significant differences in terms of the wrist ROM, DASH score and VAS at 12 months after operation among the three groups ( P>0.05). There were 2 patients in the volar plate group with reduction loss, 3 patients with wrist chronic pain; 1 patient in the volar plate combined with dorsal plate group with dorsal tendon irritation, and no complications in the volar plate combined with dorsal screw group. Conclusion:For AO C-type distal radius fractures accompanied with a dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet, the use of combined volar and dorsal internal fixation can improve the reduction accuracy and stability of the dorsoulnar fragment, and contribute to the early rehabilitation of postoperative wrist joint function. The effect of combined dorsal screw is comparable to that of dorsal plate internal fixation, but the complications of screw internal fixation are less.
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Objective:To compare the clinical outcomes between anatomical locking plate, proximal humerus internal locking system (PHILOS) and anatomical locking plate combined with suture anchors in the treatment of comminuted fractures of humeral greater tuberosity.Methods:A total of 33 comminuted fractures of humeral greater tuberosity were surgically treated from October 2016 to October 2021 at Department of Orthopedics, Tongji Hospital Affiliated to Tongji University. There were 20 males and 13 females, with an age of (53.5±13.6) years. They were assigned into 3 groups according to different internal fixation techniques. Group A of 12 cases was subjected to fixation with anatomical locking plate via the deltoid approach, group B of 10 cases subjected to fixation with PHILOS via the pectoralis major and the deltoid approaches and group C of 11 cases subjected to fixation with anatomical locking plate combined with suture anchors via the deltoid approach. The operation time, intraoperative blood loss, range of shoulder motion, Constant-Murley shoulder score, visual analogue scale (VAS) and postoperative complications were compared between the 3 groups.Results:The 3 groups were comparable because there was no significant difference between them in the general clinical data ( P>0.05). The follow-up duration for all patients was (14.5±4.1) months. All fractures got united at the last follow-up. In groups A, B and C, respectively, the operation time was (57.9±7.8), (73.0±7.1) and (63.6±9.5) min, and the intraoperative blood loss (41.7±18.9), (82.0±22.9) and (46.4±13.6) mL, showing significant differences between the 3 groups ( P<0.05). The operation time and intraoperative blood loss in groups A and C were significantly less than those in group B ( P< 0.05). At the last follow-up, in groups A, B and C, respectively, the shoulder abduction was 144.0°±7.7°, 138.7°±10.7° and 148.5°±6.2°, showing significant differences between the 3 groups ( P<0.05). Group C was significantly better than group B ( P<0.05). There was no statistically significant difference in the forward flexion, external rotation, or internal rotation of the shoulder joint between the 3 groups ( P>0.05). The Constant-Murley scores in groups A, B and C, respectively, were (90.4±5.7), (86.1±6.6) and (93.1±3.4) points, showing significant differences between the 3 groups ( P<0.05). Group C was significantly better than group B ( P<0.05). The VAS scores in groups A, B and C, respectively, were 1 (0, 2), 1 (0, 2), and 1 (0, 1) point, showing insignificant differences between the 3 groups ( P>0.05). Group A had 1 case of shoulder joint stiffness and 1 case of fracture re-displacement complicated with acromial impingement syndrome, group B 1 case of shoulder joint stiffness and 3 cases of fracture re-displacement, but group C no post-operative complication. Conclusions:In the treatment of comminuted fracture of humeral greater tuberosity, all the 3 internal fixation techniques can lead to fine clinical outcomes. Conventional PHILOS may lead to relatively large trauma and a high incidence of postoperative complications. The anatomical locking plate may result in fine functional recovery of the shoulder due to advantages of less invasion, shorter operation time and fewer postoperative complications than PHILOS. The anatomical locking plate combined with suture anchors may lead to the best shoulder functional recovery and the least complications.
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Objective:To explore the risk factors that may affect the stabilization of dorsal intra-articular fragment in distal radius fracture after volar internal fixation.Methods:A retrospective analysis was performed of the patients with distal radius fracture who had been treated by volar internal fixation at Department of Traumatic Orthopedics, Tongji Hospital Affiliated to Tongji University from July 2016 to July 2020. After 3D reconstruction of their preoperative CT scans by software Mimics 20.0, 66 patients with a dorsal intra-articular fragment were screened out. They were 31 males and 35 females, aged from 23 to 78 years (average, 53.4 years). By the AO classification, there were 17 case of type C1, 22 cases of type C2, and 27 cases of type C3. The displacement of dorsal intra-articular fragment was judged by X-ray observation on postoperative day 2 and X-ray follow-up at the outpatient department. The 13 patients with displacement of dorsal intra-articular fragment>2 mm were assigned into a displacement group while the other 53 ones into a displacement-free group. The 2 groups were compared in terms of preoperative general data and anatomical data of the dorsal intra-articular fragment (total preoperative displacement, radius-ulnar length, dorsal-volar length, aspect ratio, proximal-distal length and volume) to analyze the correlations between them and displacement.Results:There was no significant difference in preoperative general data (age, gender, affected side, cause of injury or AO classification) between the 2 groups, showing comparability between groups ( P>0.05). All patients were followed up for 6 to 24 months (mean, 14 months) after surgery. There were no postoperative complications like neurovascular lesion or infection. None of the patients in the displacement group underwent revision surgery, and the fractures healed successfully during the postoperative follow-up. The total preoperative displacement in the displacement group was(10.0±1.3) mm, significantly larger than that in the displacement-free group [(7.8±1.5) mm]; the radius-ulnar length in the displacement group was (8.2±1.3) mm, significantly shorter than that in the displacement-free group [(10.8±2.3) mm]; the aspect ratio of the fragment in the displacement group was 1.2±0.2, significantly lower than that in the displacement-free group (1.4±0.2); the fragment volume in the displacement group was (690.5± 201.4) mm 3, significantly smaller than that in the displacement-free group [(995.8±295.0) mm 3]. There were significant differences in the above items between the 2 groups ( P<0.05). Conclusion:The total preoperative displacement, radius-ulnar length, aspect ratio and volume of a dorsal intra-articular fragment are important factors which may affect the displacement of the dorsal fragment after volar internal fixation.
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Objective:To study the coronal bone structure matching of distal radius in normal population and some patients with postoperative distal radius fracture, and to explore the clinical significance of coronal bone structure reduction of distal radius fracture.Methods:CT scans of 80 asymptomatic wrists were performed. Mimics 20.0 and 3-Matic research software were used to measure the matching data of coronal bone structure of the distal radius. Total of 44 patients with distal radius fractures treated with open reduction and volar plate fixation were collected. According to the data coronal bone structure of the distal radius, the matching group was in the normal range, and the mismatching group was less than the normal range. X-ray films were used to evaluate fracture healing, humeral height, ulnar angle and palm tilt angle at 3 months and 12 months after operation. The clinical indexes of wrist pain, wrist function, grip strength and activity were recorded in 2 groups. The DASH score was used for evaluation, and statistical comparisons was made between the two groups of related indicators.Results:The coronal bone structure matching value of the distal radius in 80 normal adults was 45.0%±16.2%. All the 44 patients with distal radius fracture were followed up for an average of 16 months. The postoperative wound healing was good, and the bone healing standard was reached 3 months after the operation. 3 months after surgery, radius height, ulnar deviation angle and palmar inclination angle of the mismatched group were all smaller than those of the matched group, but the differences had no statistical significance. The pronation angle in the mismatched group (68.82°±11.62°) was lower than that in the matched group (76.91°±9.14°), and the difference was statistically significant ( t=2.567, P=0.014). The DASH score in the mismatched group (15.53±2.36) was higher than that in the matched group (13.62±2.52), and the difference was statistically significant ( t=2.591, P=0.013). 12 months after surgery, the VAS score of the matched group (2.08±2.95) was less than that of the mismatched group (2.95±1.24), and the difference was statistically significant ( t=2.348, P=0.024). There was no significant difference in wrist range of motion, grip strength and DASH score between the two groups. Conclusion:The coronal bone structure matching of distal radius is about 45.0% in normal population. Early wrist dysfunction, limited pronation, and wrist pain may occur when the postoperative matching degree of the distal radius fracture is not within the normal range.
