초록
Purpose:
The 2.4 mm variable-angle locking compression plate (VA-LCP) is designed to treat a variety of distal radius fracture patterns. The purpose of this study was to evaluate the efficacy of the 2.4 mm VA-LCP in treating unstable distal radius fractures.
Methods:
We recruited eligible patients treated with the device at two Korean sites. In total, we studied 61 enrolled patients. We assessed clinical outcomes and radiographic union, as well as the types of plates and the number of variable-angle locking screws used in the treatment of each fracture type. Radiographic parameters were evaluated at the immediate postoperative period and at 1 year after operation.
Results:
A total of five complications occurred in 61 patients (8.2%). Radiographic union was achieved in 46/51 (90.2%), 50/51 (98.0%), and 51/51 (100%) patients at 3, 6, and 12 months, respectively. Radiographic parameters evaluated at the immediate postoperative period were 22.4±4.2 degrees (radial inclination), 4.7±0.4 degrees (volar tilt) and 0.8±0.2 degrees (ulnar variance). Radiographic parameters evaluated at 1 year after operation were 21.3±3.4 degrees (radial inclination), 4.1±0.4 degrees (volar tilt) and 1.2±0.3 degrees (ulnar variance). Wrist range of motion and grip strength measure-ments, as well as self-administered patient questionnaires showed continuous improvements at all follow-up time points. The mean number of screws that were inserted through variable-angle screw guide was 3.2±0.9, while that of screws inserted through fixed-angle screw guide was 3.5±0.9. The majority of patients (85.3%) were treated with a narrow plate.
REFERENCES
1.Leung F., Chow SP. A prospective, randomized trial com-paring the limited contact dynamic compression plate with the point contact fixator for forearm fractures. J Bone Joint Surg Am. 2003. 85:2343–8.
2.Letsch R., Infanger M., Schmidt J., Kock HJ. Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position. Arch Orthop Trauma Surg. 2003. 123:333–9.
3.Rozental TD., Beredjiklian PK., Bozentka DJ. Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg Am. 2003. 85:1956–60.
4.Rein S., Schikore H., Schneiders W., Amlang M., Zwipp H. Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study. J Hand Surg Am. 2007. 32:954–61.
5.Ring D., Prommersberger K., Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am. 2004. 86:1646–52.
6.Gummesson C., Atroshi I., Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003. 4:11.
7.Chung KC., Watt AJ., Kotsis SV., Margaliot Z., Haase SC., Kim HM. Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am. 2006. 88:2687–94.
8.Osada D., Kamei S., Masuzaki K., Takai M., Kameda M., Ta-mai K. Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am. 2008. 33:691–700.
9.Rozental TD., Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006. 31:359–65.
10.Kwan K., Lau TW., Leung F. Operative treatment of distal radial fractures with locking plate system-a prospective study. Int Orthop. 2011. 35:389–94.
11.Phadnis J., Trompeter A., Gallagher K., Bradshaw L., Elliott DS., Newman KJ. Mid-term functional outcome after the internal fixation of distal radius fractures. J Orthop Surg Res. 2012. 7:4.
12.MacDermid JC., Richards RS., Roth JH. Distal radius fracture: a prospective outcome study of 275 patients. J Hand Ther. 2001. 14:154–69.
13.MacDermid JC., Roth JH., Richards RS. Pain and disability reported in the year following a distal radius fracture: a cohort study. BMC Musculoskelet Disord. 2003. 4:24.
14.Stanbury SJ., Salo A., Elfar JC. Biomechanical analysis of a volar variable-angle locking plate: the effect of cap-turing a distal radial styloid fragment. J Hand Surg Am. 2012. 37:2488–94.
15.Hart A., Collins M., Chhatwal D., Steffen T., Harvey EJ., Martineau PA. Can the use of variable-angle volar locking plates compensate for suboptimal plate positioning in unstable distal radius fractures? A biomechanical study. J Orthop Trauma. 2015. 29:e1–6.
16.Fowler JR., Ilyas AM. Prospective evaluation of distal radius fractures treated with variable-angle volar locking plates. J Hand Surg Am. 2013. 38:2198–203.
17.Marlow WJ., Singhal R., Dheerendra S., Ralte P., Fischer J., Waseem M. Distal radius volar locking plates: does a variable angle locking system confer a clinical advantage? Acta Orthop Belg. 2012. 78:309–16.
18.Lim ST., Yeom JS., Lee CH., Lee YH., Chang CB., Baek GH. Development of anatomical plating system for treatment of distal radius fractures. J Korean Soc Surg Hand. 2007. 12(3):95–104.