Comparison of bone mineral density and vertebral fracture assessment in postmenopausal women with and without distal radius fractures

Tanawat Amphansap,Chayaphong Rattanaphonglekha,Jaruwat Vechasilp,Nitirat Stitkitti,Kamonchalat Apiromyanont,Atiporn Therdyothin 대한골다공증학회 2021 Osteoporosis and Sarcopenia Vol.7 No.4

Objectives: To compare bone mineral density (BMD) in Thai postmenopausal women with and without distal radius fracture, and to investigate the role of vertebral fracture assessment (VFA) in diagnosing osteoporosis after distal radius fracture. Methods: A cross-sectional study was conducted in Thai postmenopausal women with and without distal radius fracture. BMDs of the femoral neck (FN), total hip (TH), lumbar spine (LS), and VFA were obtained within 2 weeks of injury. BMD were compared between groups. Participants were classified into osteoporosis, osteopenia or normal using BMD alone, and BMD plus VFA, where a mere presence of vertebral compression fracture indicated osteoporosis. Results: Fifty postmenopausal women with distal radius fractures and 111 non-fracture postmenopausal women participated. The mean BMD was significantly lower at all sites in the fracture group (FN BMD 0.590 ± 0.075 vs 0.671 ± 0.090, p = 0.007; TH BMD 0.742 ± 0.103 vs 0.828 ± 0.116, P = 0.009; LS BMD 0.799 ± 0.107 vs 0.890 ± 0.111, P = 0.009 in the fracture vs non-fracture group respectively). VFA increased the prevalence of osteoporosis from 16 (32%) to 23 (46%) in the fracture group, and 7 (6.31%) to 17 (16.22%) in the non-fracture group, with a number needed to treat 9. Objectives: To compare bone mineral density (BMD) in Thai postmenopausal women with and without distal radius fracture, and to investigate the role of vertebral fracture assessment (VFA) in diagnosing osteoporosis after distal radius fracture. Methods: A cross-sectional study was conducted in Thai postmenopausal women with and without distal radius fracture. BMDs of the femoral neck (FN), total hip (TH), lumbar spine (LS), and VFA were obtained within 2 weeks of injury. BMD were compared between groups. Participants were classified into osteoporosis, osteopenia or normal using BMD alone, and BMD plus VFA, where a mere presence of vertebral compression fracture indicated osteoporosis. Results: Fifty postmenopausal women with distal radius fractures and 111 non-fracture postmenopausal women participated. The mean BMD was significantly lower at all sites in the fracture group (FN BMD 0.590 ± 0.075 vs 0.671 ± 0.090, p = 0.007; TH BMD 0.742 ± 0.103 vs 0.828 ± 0.116, P = 0.009; LS BMD 0.799 ± 0.107 vs 0.890 ± 0.111, P = 0.009 in the fracture vs non-fracture group respectively). VFA increased the prevalence of osteoporosis from 16 (32%) to 23 (46%) in the fracture group, and 7 (6.31%) to 17 (16.22%) in the non-fracture group, with a number needed to treat 9. Conclusions: Postmenopausal women with distal radius fractures had lower BMD. Incorporating VFA into diagnosis of osteoporosis increased the prevalence of osteoporosis in both fracture and non-fracture groups. Postmenopausal women aged 50 years or older with distal radius fracture are a good target for the investigation of osteoporosis.

주상골 골절 동반 여부에 따른 원위 요골 골절의 비교

오진록,이동우,이준표 대한수부외과학회 2016 대한수부외과학회지 Vol.21 No.1

Purpose: Distal radius fracture is one of the most common factures, but incidence of concomitant scaphoid fracture is rare. The rarity makes diagnosing the concomitant scaphoid fracture often delayed. Thus, in this study, the authors examined the frequency of concomitant scaphoid injury in distal radius fracture and the type of distal radius fracture that is more commonly associated with simultaneous scaphoid fracture. Methods: We examined a total of 212 patients who had received treatment for the fracture in our institution. They were divided into two groups, isolated distal radius fracture group and distal radius fracture group with simultaneous scaphoid fracture, and their age, gender, body mass index and distal radius fracture type in accordance with AO classification were compared between the two groups. Results: Concomitant scaphoid fractures were found in 12 (5%) patients, and among them 10 cases were associated with type C distal radius fracture. Statistical comparison between the group with isolated distal radius fracture and the group with both distal radius and scaphoid fractures was made, and only comparison of distal radius fracture types showed statistical significance. Conclusion: It is imperative to make timely and appropriate diagnosis of accompanying scaphoid fracture, since delay in making the diagnosis usually lead to many complications. We conclude that further diagnostic imaging such as computed tomography is necessary to make the correct diagnosis of concomitant scaphoid fracture, especially in type C distal radius fractures. 목적: 원위 요골 골절은 매우 흔한 골절 중 하나이지만 주상골 골절이 동반된 경우는 흔하지 않아 종종 그 진단이 늦어져 어려움에 직면하는 경우가 있다. 본 연구에서는 원위 요골골절에서 동반되는 주상골 골절의 발생빈도와 원위 요골골절의 양태와의 관련성 여부를 조사 및 평가하였다. 방법: 본원에서 원위 요골 골절로 치료를 받은 212명의 환자들을 단면조사연구를 통해 주상골 골절이 동반된 사례에 대해서 평가를 시행하였다. 주상골 골절이 동반된 군과 동반되지 않은 군으로 나누어, 나이, 성별, 체질량 지수, 원위 요골골절의 AO분류를 비교 분석하였다. 카이 제곱 검정(chi-square test)을 시행하였다. 결과: 주상골 골절이 동반된 수는 12명(5%)이었다. 12명의 주상골 골절 환자 중에서 10명에서 원위 요골골절의 AO분류 C type이 관찰되었으며, 이는 두 군 간의 유의한 차이를 보였다. 결론: 원위 요골 골절과 동반된 주상골 골절은 치료가 적절히 시행되지 못하고 방치되는 경우가 많고, 그 결과 주상골골절에 따른 합병증이 발생할 수 있어, 조기 진단이 매우 중요하다. 따라서 주상골 동반 손상여부를 판단하기 위해 조기컴퓨터단층촬영이 필요하다.

Korean Type Distal Radius Anatomical Volar Plate System: A Preliminary Report

김정환,이혁진,김지형,김민봄,이성환,공현식,이영호,백구현 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.3

Background: Distal radius fracture is the most common fracture of the upper extremity, and approximately 60,000 distal radius fractures occur annually in Korea. Internal fixation with an anatomical volar locking plate is widely used in the treatment of unstable distal radius fractures. However, most of the currently used distal radius anatomical plate systems were designed based on the anatomical characteristics of Western populations. Recently, the Korean-type distal radius anatomical volar plate (K-DRAVP) system was designed and developed based on the anatomical characteristics of the distal radius of Koreans. The purpose of this study was to evaluate the preliminary results of the new K-DRAVP system, and to compare its radiologic and functional results with those of the other systems. Methods: From March 2012 to October 2012, 46 patients with acute distal radius fractures who were treated with the K-DRAVP system at three hospitals were enrolled in this study. Standard posteroanterior and lateral radiographs were obtained to assess fracture healing, and three radiographic parameters (volar tilt, radial inclination, and radial length) were assessed to evaluate radiographic outcomes. The range of motion and grip strength, the Gartland and Werley scoring system, and the disabilities of the arm, shoulder and hand (DASH) questionnaire were used to assess clinical and functional outcomes. Results: All radiologic parameters were restored to normal values, and maintained without any loosening or collapse until the time of final follow-up. Grip strength was restored to 84% of the value for the unaffected side. The mean range of motion of the wrist at final follow-up was restored to 77%−95% of the value for the unaffected side. According to the Gartland and Werley scoring system, there were 16 excellent, 26 good, and 4 fair results. The mean DASH score was 8.4 points. There were no complications after surgery. Conclusions: The newly developed K-DRAVP system could be used to restore and maintain good anatomical parameters, and provide good clinical outcomes with low complication rates. This system is a promising surgical option for the treatment of distal radius fractures in the Korean population.

요골 원위부 관절내 골절과 관련된 원위 요척 관절 손상

김우식 ( Woo Sik Kim ),김용상 ( Yong Sang Kim ),전환용 ( Whan Yong Chung ),이우석 ( Woo Suk Lee ),전택수 ( Taek Soo Jeon ),류승렬 ( Seung Ryul Ryu ) 대한골절학회 2006 대한골절학회지 Vol.19 No.2

목적: AO 분류 C형 요골 원위부 골절에서 원위 요척 관절 손상이 동반된 경우를 분류하고 각각의 치료 결과를 비교 분석하여 원위 요척 관절 손상이 전체 결과에 얼마만한 영향을 미치는지에 대해 알아보고자 한다. 대상 및 방법: 2000년 10월부터 2005년 8월까지 AO 분류 C형 요골 원위부 골절로 수술받은 환자 58예를 대상으로 하였다. 남자가 36명, 여자가 22명이었고 평균 추시 기간은 14개월이었다. 수상 당시 전후면 방사선 사진에서 원위 요척 관절 손상의 증거가 없는 군을 1군 (13예), 척골 경상 돌기 골절이 있는 군을 2군 (20예), 원위 요척 관절 분리가 있는 군을 3군 (11예), 척골 경상 돌기 골절과 원위 요척 관절 분리가 동반된 군을 4군 (9예), 수상 당시 측면 방사선 사진상 척골의 전후방 전위가 있는 군을 5군 (5예)으로 나누었다. 각 군의 수술 전후 및 최종 추시 방사선 사진에서 요측 관절면 경사, 전방 경사, 요측 길이를 측정하였고 Scheck의 평가 방법에 의거하여 평가하였으며, 임상적 평가 방법으로 Sarmiento의 Demerit Point System을 사용하여 각 군의 치료 결과를 비교하였다. 결과: Scheck의 평가 방법에 따른 방사선학적 결과 및 Demerit Point System에 따른 임상적 결과는 각 군에서 통계학적으로 유의한 차이는 없었다 (p>0.05). 결론: 요골 원위부 관절내 분쇄 골절에서 단순 방사선 사진상 원위 요척 관절 손상이 의심되는 여러 군을 비교해 본 결과, 원위요골의 해부학적 정복이 만족할 만한 경우에 있어서는 원위 요척 관절의 손상이 전체 결과에 큰 영향을 미치지 않는 것으로 생각된다. Purpose: To evaluate the significance of distal radioulnar joint injury which may affect the postoperative radiologic and clinical results of AO classification, type C distal radius fractures. Materials and Methods: From October 2000 to October 2005, 58 patients of AO classification, type C distal radius fracture, who had been treated with operative methods were studied. They are thirty-six men and twenty-two women. The average follow up period was 14 months. The patients were divided into five groups. In the first group (13 cases), there was no distal radioulnar joint injuries. In the second group (20 cases), there were ulnar styloid fractures. In the third group (11 cases), there were separation of distal radioulnar joint. In the fourth group (9 cases), there were ulnar styloid fractures with separation of distal radioulnar joint. In the fifth group (5 cases), there were displacement of ulna in sagittal plane. We measured the radial length, radial inclination and volar tilt in plain radiograph in each group and analyzed the results through Scheck`s methods. To analyzed the clinical results, we used the Demerit Point System by Sarmiento. Results: There was no significant differences in radiologic and clinical results among the five groups. Conclusion: According to compairing the radiologic results of each group which was suspicious of distal radioulnar joint injuries, in the intraarticular comminuted fractures of distal radius, the distal radioulnar joint injuries did not affect the results of treatment when anatomical reduction of distal radius was achieved.

자발적 장무지 신전건 파열이 일어난 원위 요골 골절의 방사선적 분석

이준구 ( Jun-ku Lee ),홍인태 ( In-tae Hong ),권영우 ( Young-woo Kwon ),장규철 ( Gyu-chol Jang ),한수홍 ( Soo-hong Han ) 대한골절학회 2017 대한골절학회지 Vol.30 No.2

목적: 원위 요골 골절 후 발생한 장무지 신전건의 자발성 파열로 분당차병원에서 치료받은 환자들의 방사선적 분석을 시행하였다. 대상 및 방법: 원위 요골 골절 발생 이후 자발성 무지 신전건파열이 발생하여 수술적 치료가 시행된 28예를 대상으로 하였으며, 요골 골절에 대해 정복 내지는 내고정술을 시행한 경우는 제외하였다. 건파열 후 첫 번째 내원 시 시행한 방사선 사진을 분석하였으며 손목 관절 전후면 방사선 사진을 통하여 월상와에서 골절 선까지의 거리를 측정하였다. 측면 사진을 통하여 리스터 결절(Lister`s tubercle)의 높이와 골절 선까지의 길이를 측정하였고, 편측의 손목 관절 방사선 사진으로 그 높이를 비교하였다. 결과: 25예에서 비전위성 골절 양상을 보였으며, 전위 골절 3예에서는 평균 2.0 mm의 전위를 보여주었다. 월상와에서 골절 선까지 거리는 평균 9.1 mm였으며, 리스터 결절의 정점으로부터 근위부의 골절선까지는 평균 3.0 mm였다. 리스터 결절의 높이는 3.4 mm였으며 건측은 3.1 mm였다. 결론: 2 mm 이하의 전위, 리스터 결절 3 mm 이내의 원위 요골 골절 시 빈도는 낮지만 장무지 신전건 파열 가능성에 대한 인지 및 사전 설명이 필요하다. Purpose: The spontaneous extensor pollicis longus (EPL) tendon rupture is a well-documented complication of non-displaced or minimally displaced distal radius fracture. Authors analyzed the radiographs of patients treated for closed EPL rupture after distal radius fracture. Materials and Methods: Twenty-eight patients (21 females, 7 males; average age of 58 years) with tendon transfer for spontaneous rupture of EPL after distal radius fracture were included. Wrist radiographs were taken at the first visit with EPL rupture. On the lateral view, posterior cortical displacement, distance from highest point in Lister`s tubercle to fracture line, and height of the Lister`s tubercle were measured. The distance from the lunate facet to the fracture line was measured on anteroposterior view. Radiologic change at the time of EPL rupture around the Lister`s tubercle was evaluated by comparing it with the contra lateral wrist radiograph. Radial beak fracture pattern was also identified. Results: The interval between the injury and the spontaneous EPL rupture varied from 2 to 20 weeks, with an average of 6.7 weeks. There were 25 cases of non-displacement, 3 cases of mean 2.0 mm cortical displacement. The average distance from the lunate facet to the fracture line was 9.1 mm (3-12.1 mm), from the highest point in Lister`s tubercle to the fracture line was 3.0 mm toward proximal radius (1.7-4.9 mm). The average height of the Lister`s tubercle was 3.4 mm in the injured wrist and 3.1 mm in the opposite wrist. Radial beak fracture pattern was shown at 11 cases. Conclusion: All cases presented no or minimal displaced fracture, and the fracture line was in the vicinity of the Lister`s tubercle. Those kinds of fractures can highlight the possibility of spontaneous EPL rupture, depites its rarity.

원위 요골 골절과 동반된 수근부 손상: 단순 방사선 및 컴퓨터 단층 촬영을 통한 후향적 분석

조철현 ( Chul Hyun Cho ),손은석 ( Eun Seok Son ) 대한골절학회 2015 대한골절학회지 Vol.28 No.1

목 적: 원위 요골 골절에 동반된 수근부 골절 및 인대 손상의 빈도 및 양상을 알아보고, 그 위험 인자를 분석하고자 하였다. 대상 및 방법: 362명 379예를 대상으로 하였으며, 수상 당시의 단순 방사선 사진과 전산화 단층 촬영을 통해 수근부 골절 및 인대 손상을 평가하였으며, 여러 인자들과의 연관성을 분석하였다. 결 과: 39예(10.3%)에서 1개 이상의 수근골 골절이, 40예(10.6%)에서 수근골간 인대 손상이 동반되어 총 59예(15.6%)에서 수근부 손상이 관찰되었다. 수근골간 인대 손상은 젊은 연령과, 수근골 골절은 AO B형 골절과 연관성이 있었다. 남자, 고에너지 손상, 완관절 주위 이외의 동반 손상이 있었던 경우에 수근부 골절 및 인대 손상이 잘 발생하는 것으로 나타났다. 결 론: 원위 요골 골절 환자에서 비교적 높은 빈도에서 수근부 손상이 동반되었으며, 젊은 연령, 남자, 고 에너지 손상, AOB형 골절, 동반 손상이 있는 경우에 수근부 손상의 빈도가 높게 나타났다. Purpose: The purpose of this study is to evaluate the incidence and characteristics of concomitant carpal bone fractures and ligament injuries and to analyze risk factors for carpal injuries in patients with distal radius fractures. Materials and Methods: A total of 362 patients with 379 distal radius fractures were reviewed retrospectively. Associated carpal bone fractures and ligament injuries were evaluated by plain radiographs and computed tomography at the time of initial trauma. Correlation between associated carpal injuries and various parameters was also analyzed. Results: Of 379 distal radius fractures, 39 cases (10.3%) had one or more carpal bone fracture and 40 cases (10.6%) had carpal ligament injuries. Overall, carpal injuries occurred in 59 cases (15.6%) distal radius fractures. Associated carpal ligament injuries showed correlation with young age and associated carpal bone fractures showed correlation with AO type B distal radius fractures. Carpal injuries including fracture and ligament injury showed correlation with male, high energy trauma, or associated injuries beyond wrist. Conclusion: The incidence of concomitant carpal injuries in patients with distal radius fractures is relatively high. Concomitant carpal injuries were more common in young age, male, high energy trauma, AO type B distal radius fractures, or associated injuries beyond wrist.

연령에 따른 소아 원위요골 골절의 양상 비교

송경섭,이승환,박병문,이수건,양봉석,김지현 대한수부외과학회 2019 대한수부외과학회지 Vol.24 No.2

Purpose: To compare demographic factors and radiologic parameters between metaphyseal fracture and physeal fracture of distal radius in children.Methods: Forty-five children who visited our orthopedic clinic for distal radius fracture were included in this study from May 2010 to February 2017. Patients were divided into 2 groups which are metaphyseal fracture group and physeal frac-ture group. Demographic factors and radiologic parameters were compared between two groups. Mean age of all patients was 10.18±2.66 years old. There were 39 boys and 6 girls in all patients.Results: Among all patients, 26 patients were diagnosed with metaphyseal fracture, 19 patients with physeal fracture. Complete fracture was most frequent in metaphyseal group and Salter–Harris type II fracture was most frequent in phy-seal group. Between simple metaphyseal group and physeal group, mean age, weight and height were significantly larger in physeal group. Ratio of patients over 10 years old was significantly higher in physeal group than metaphyseal group (p=0.036). There was no significant difference in radiologic and clinical results.Conclusion: Physeal fracture occurs more frequently more than 10 years old. Postoperative radiologic result was not sig-nificantly different between two groups. In children with distal radius fracture over 10 years old, evaluation for the injury of growth plate are recommended. 목적: 소아의 원위 요골 골절에서 골간단부 골절(metaphyseal fracture)과 골단부 골절(physeal fracture) 사이의 인구통계적 요소와 방사선적 지표를 비교해 보고 이를 통한 임상적 의의를 확인하기 위해 본 연구를 시행하였다.방법: 2010년 5월부터 2017년 2월까지 원위 요골 골절로 본원 정형외과 외래를 방문한 45명의 소아를 대상으로 연구를 진행하였다. 환아들은 골절의 형태에 따라 골간단부 골절과 골단부 골절의 두 군으로 나누었고, 두 군 사이의 인구통계적 요소와 방사선적 지표를 비교하였다. 모든 환아의 평균 연령은 10.18±2.66세였으며, 이 중 남아가 39명, 여아가 6명이었다.결과: 분류상 골간단부 골절 환아는 26명, 골단부 골절 환아는 19명이었다. 골간단부 골절군과 골단부 골절군 사이에서 인구통계적 요소를 비교했을 때, 골단부 골절군에서 평균 연령, 체중 및 신장이 유의하게 컸다. 그룹 내에서 10살 이상의 환아가 차지하는 비율은 골단부 골절군에서 유의하게 더 컸다(p=0.036). 골절 유합 후에 두 군 간에 임상적, 방사선적 결과의 차이는 없었다.결론: 원위 요골 골절에 대한 비교 연구에서 10살 이상의 환아들에서는 골단부 골절이 호발하였다. 10세 이상의 환자에서 원위 요골 골절 시에는 성장판 손상 여부에 대한 방사선적 검사가 필요할 것으로 생각된다.

요골 원위부 골절에 합병된 장무지 굴곡건 파열 -증례 보고-

김도영 ( Do Young Kim ),서은민 ( Eun Min Seo ),남우동 ( Woo Dong Nam ),박승재 ( Seung Jae Park ),이상수 ( Sang Soo Lee ) 대한골절학회 2011 대한골절학회지 Vol.24 No.2

요골 원위부 골절에 합병된 장무지 신전건 파열은 종종 보고되었으나, 장무지 굴곡건 파열은 보고된 예가 극히 드물다. 저자들은 개방성 창상이 없이 원위부 요골 골절에 합병된 장무지 굴곡건 파열을 1예 치험하였기에 문헌 고찰과 함께 보고하는 바이다. 24세 남자 환자로 전위가 심한 요골 원위부 골절에 대해 도수 정복술을 시행받고, 3일째 무지 지관절 굴곡 운동제한과 전완부의 통증을 호소하였다. 이학적 검진상 장무지 굴곡건 파열이 의심되어 탐색술을 시행하였다. 수술 소견상 요골 골절부위에서 장무지 굴곡건의 파열을 확인할 수 있었고, 건봉합술과 골절부위에 대해 수장부 금속판 고정술을 시행하였다. 요골 원위부 골절 시 신전건뿐만 아니라 굴곡건의 파열도 합병될 가능성을 고려하여, 면밀한 이하적 검진을 시행하여야 하겠고, 특히 도수 정복술을 시행하였을 경우 더욱 세심한 관찰이 필요하다. There are few reported cases of flexor pollicis longus tendon (FPL) rupture complicating a closed distal radius fracture. We report a case of FPL tendon rupture complicating a closed distal radius fracture. A 24-year-old male presented with a severe right wrist pain. He had a closed distal radius fracture that was treated by closed manual reduction. Three days later, he complained forearm pain and limitation of thumb motion. The physical examination revealed loss of active interphalangeal joint flexion of thumb. He was taken to the operating room. Intraoperatively, the FPL was found to be discontinuous at the level of the radius fracture site. The FPL was repaired by a modified Kessler technique, and the fracture was repaired with a volar plate. Clinicians must be cautious in possibility of tendon injury complicating a closed distal radius fracture and assessing patients with distal radius fracture following closed reduction.

원위 요골 골절과 동반된 척골 골절의 치료

김재광(Jae Kwang Kim),김종오(Jong-Oh Kim),윤여헌(Yeo-Hon Yun) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.2

원위 요골 골절 중 약 5-6%에서 원위 척골 골절이 동반되는 것으로 알려져 있는데, 고령의 골다공증 환자에서 빈번하다. 원위 요골 골절의 고정 후 원위 척골 골절이 안정된다면 석고 고정만으로 치료도 가능하지만, 원위 척골 골절부에 부정 정렬이 있어나 불안정성이 있을 때는 수술적 치료를 시행한다. 원위 척골 골절의 수술적 방법으로는 K-강선, 골수강 내 금속정, 금속판을 이용한 내고정술과 척골두 절제술이나 Sauve-Kapandji 술식과 같은 구제술 등이 있다. 척골 경상돌기 골절은 약 50%의 원위 요골 골절에서 동반된다. 이 골절은 수술적으로 치료하지 않으면 약 50-70%에서는 유합되지 않지만, 대부분의 경우에 증상을 유발하지 않는다. 최근 원위 요골 골절 치료로 잠김 금속판을 사용한 문헌 보고들은 척골 경상돌기 골절의 존재나 그 크기가 손목의 기능에 영향을 미치지 않는다고 보고하고 있다. Approximately 5-6% of distal radius fractures have a concomitant distal ulnar fracture, this incidence is more frequent in osteoporotic elderly patients. When the distal ulnar fracture is stable after fixation of the distal radius fracture, the distal ulnar fracture can be managed with cast immobilization. However, when the distal ulnar fracture shows malalignment or instability, an operative method should be used. The operative method for distal ulnar fracture includes internal fixation using a K-wire, intramedullary nail, or plates and salvage procedures including ulnar head resection or Sauve-Kapandji procedure. Approximately 50% of distal radius fractures are combined with ulnar styloid process fracture. Although approximately 50-70% of ulnar styloid process fractures result in nonunion if they are not treated by an operative method, they tend to be asymptomatic. Recent studies of distal radius fracture treated using a volar locking plate have generally reported that neither the presence nor the size of concomitant ulnar styloid fracture has an effect on clinical outcome.

Use of Miniplate for Severe Comminuted Metadiaphyseal Fractures of the Distal Radius

백종륜,윤용철,백승현 대한골절학회 2019 대한골절학회지 Vol.32 No.4

Purpose: This study investigated the clinical and radiological outcomes of patients undergoing provisional fixation in conjunction with locking plate fixation. Miniplates were used as the reduction plates for the surgical treatment of severe comminuted metadiaphyseal fractures with an intra-articular fracture of the distal radius. Materials and Methods: The radial length, radial inclination, volar tilt, and radial intra-articular stepoff were measured preoperatively, postoperatively, and at one year after surgery in 12 patients (eight males, four females, mean age 55.4 years old). The patients underwent volar locking plate fixation with miniplate as a reduction plate for severe comminuted metadiaphyseal fractures with an intra-articular fracture of the distal radius. Clinical evaluations were conducted using the modified Mayo wrist score (MMWS). Results: Bone union was achieved in all cases. The mean MMWS was 81.8 points, including two excellent, three good, and seven fair cases. Radiological improvements were observed in the average radial length (preoperative, 6.4 mm; postoperative, 11.8 mm), average radial inclination (10.2° to 22.4°), average volar tilt (–4.5° to 10.6°), and average radial intra-articular step-off (4.8-0.8 mm) (all, p<0.05). Radiographic measurements obtained immediately after surgery and at the final follow-up revealed insignificant decreases in radial length (0.6 mm), radial inclination (0.4°), and volar tilt (0.9°) (all, p>0.05). Conclusion: Miniplate fixation can be an effective treatment option as a reduction plate for the treatment of distal radial fractures, which is challenging to reduce and maintain due to severely comminuted metadiaphysis fractures with the intra-articular fracture.