Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical and Radiological Results of Treating Unstable Distal Radial Fractures with a Domestically Developed Volar Locking Plate That Has the Characteristic of Double-Tiered Subchondral Support

불안정성 원위 요골 골절의 치료에 있어 한국형 이중 연골하지지고정 전방 금속판의 임상적 및 방사선학적 결과

  • Lee, Chul-Hyung (Department of Orthopedic Surgery, Daejeon Sun Hospital) ;
  • Jung, Deukhee (Department of Orthopedic Surgery, Daejeon Sun Hospital) ;
  • An, Chung-Han (Department of Orthopedic Surgery, Daejeon Sun Hospital) ;
  • Jeong, Uitak (Department of Orthopedic Surgery, Daejeon Sun Hospital)
  • Received : 2019.10.24
  • Accepted : 2020.03.10
  • Published : 2020.12.30
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to assess the effectiveness of domestically developed volar locking plate which has the concept of double-tiered subchondral support (DSS) in maintaining the reduction after distal radial fracture surgery. Materials and Methods: From July 2017 to December 2018, 54 patients were assessed. Plain radiographs were obtained immediately after surgery and at the last follow-up, and the radiographic parameters were measured in those images: radial length, radial inclination, volar tilt, ulnar variance, and distal dorsal cortical distance. The patients were subdivided into their age, type of fracture, and the position of the plate to evaluate the influence of each factors on the reduction maintenance. Results: Distal dorsal cortical distance in radiographs after the surgery was 5.91 mm (standard deviation, ±1.95 mm) on average. Significant differences in the radial length (p=0.038) and ulnar variance (p=0.001) were observed between immediately after surgery and at the last follow-up. When the parameters were evaluated by dividing the patients into subgroups according to the three specific factors, the ulnar variance showed a significant increase at the last follow-up when the patients were included 65-years-old or older. AO/OTA type C3 fracture, and Soong classification grade 0 plate position (p=0.007, p=0.012, p=0.046, respectively). Conclusion: Using the domestically developed DSS-type volar locking plate, significant reduction after distal radial fracture surgery could be maintained successfully. On the other hand, further study will be needed to determine about the reduction loss of the lunate facet identified in special cases that deal with fractures in elderly patients, unstable AO/OTA type C3 distal radial fractures, and Soong classification grade 0 plate position.

목적: 본 연구는 요골 원위부 골절에 대해 국내에서 이중 연골하 지지고정 개념으로 개발된 전방 잠김 금속판의 수술 후 정복 유지 효과 및 이에 영향을 줄 수 있는 요인들에 대해 평가해 보고자 하였다. 대상 및 방법: 2017년 7월부터 2018년 12월까지 요골 원위부 골절 환자 중 관혈적 정복 및 금속판 고정술을 시행한 54예를 대상으로 하였다. 수술 직후와 최종 추시 시 촬영한 단순방사선 사진을 이용해 요골 길이, 요골경사, 수장측 경사, 척골 변위, 원위 배측 피질 거리(distal dorsal cortical distance)를 측정하여 골절 정복 유지 효과에 대해 평가하였다. 환자 나이, 골절 분류, 금속판 위치를 기준으로 전체 환자군을 세부 그룹으로 나누어 비교함으로써 각 요인이 골절 정복 유지에 미치는 영향을 분석하였다. 결과: 수술 직후 원위 배측 피질 거리는 평균 5.91 mm (표준 편차, ±1.95 mm)로 측정되었으며 요골 길이(p=0.038), 척골 변위(p=0.001)는 수술 직후와 최종 추시 시 촬영한 단순 방사선 사진에서 유의한 차이가 확인되었다. 전체 환자군을 각 요인에 따라 세부 그룹으로 나누어 평가했을 시 척골 변위는 나이가 65세 이상이거나 AO/OTA 분류 C3형에 해당하는 경우 혹은 금속판 위치가 Soong classification grade 0에 해당하는 경우 수술 직후에 비해 최종 추시 시 유의하게 증가하였다(p=0.007, p=0.012, p=0.046). 결론: 국내에서 이중 연골하 지지고정 개념으로 생산된 전방 잠김 금속판을 이용하여 요골 원위부 골절 정복술을 시행하는 경우 충분한 정복을 확보할 수 있으며 골절 정복 유지에 대해 전반적으로 긍정적인 결과를 보이나, 환자가 고령인 경우, 관절 내 골절의 분쇄 정도가 심한 경우, 금속판이 분수령선의 근위부에 위치한 경우에 척골 변위의 증가를 보여 요골 월상골와의 정복 유지를 위한 고려가 필요하다.

Keywords

References

  1. Gehrmann SV, Windolf J, Kaufmann RA. Distal radius fracture management in elderly patients: a literature review. J Hand Surg Am. 2008;33:421-9. https://doi.org/10.1016/j.jhsa.2007.12.016
  2. Chen Y, Chen X, Li Z, Yan H, Zhou F, Gao W. Safety and efficacy of operative versus nonsurgical management of distal radius fractures in elderly patients: a systematic review and meta-analysis. J Hand Surg Am. 2016;41:404-13. https://doi.org/10.1016/j.jhsa.2015.12.008
  3. Kundu AK, Wale N, Phuljhele S, Ghritlahre D, Gurudatta HS. Intra articular distal radius fractures and volar plate fixation: a prospective study. Int J Res Orthop. 2017;3:589-94. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20171907
  4. Ruch DS, Papadonikolakis A. Volar versus dorsal plating in the management of intra-articular distal radius fractures. J Hand Surg Am. 2006;31:9-16.
  5. Neuhaus V, Badri O, Ferree S, Bot AG, Ring DC, Mudgal CS. Radiographic alignment of unstable distal radius fractures fixed with 1 or 2 rows of screws in volar locking plates. J Hand Surg Am. 2013;38:297-301.
  6. Lee SK, Chun YS, Shin HM, Kim SM, Choy WS. Double-tiered subchondral support fixation with optimal distal dorsal cortical distance using a variable-angle volar locking-plate system for distal radius fracture in the elderly. Orthop Traumatol Surg Res. 2018;104:883-91. https://doi.org/10.1016/j.otsr.2018.04.009
  7. Vosbikian MM, Ketonis C, Huang R, Ilyas AM. Optimal positioning for volar plate fixation of a distal radius fracture: determining the distal dorsal cortical distance. Orthop Clin North Am. 2016;47:235-44. https://doi.org/10.1016/j.ocl.2015.08.020
  8. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. X-ray film measurements for healed distal radius fractures. J Hand Surg Am. 1996;21:31-9.
  9. Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am. 2011;93:328-35. https://doi.org/10.2106/JBJS.J.00193
  10. Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res. 1987;214:136-47.
  11. Teunis T, Jupiter J, Schaser KD, et al. Evaluation of radiographic fracture position 1 year after variable angle locking volar distal radius plating: a prospective multicentre case series. J Hand Surg Eur Vol. 2017;42:493-500. https://doi.org/10.1177/1753193417690478
  12. Obata H, Baba T, Futamura K, et al. Difficulty in fixation of the volar lunate facet fragment in distal radius fracture. Case Rep Orthop. 2017;2017:6269081.
  13. Marcano A, Taormina DP, Karia R, Paksima N, Posner M, Egol KA. Displaced intra-articular fractures involving the volar rim of the distal radius. J Hand Surg Am. 2015;40:42-8.
  14. Beck JD, Harness NG, Spencer HT. Volar plate fixation failure for volar shearing distal radius fractures with small lunate facet fragments. J Hand Surg Am. 2014;39:670-8. https://doi.org/10.1016/j.jhsa.2014.01.006
  15. Kawasaki K, Nemoto T, Inagaki K, Tomita K, Ueno Y. Variable-angle locking plate with or without double-tiered subchondral support procedure in the treatment of intra-articular distal radius fracture. J Orthop Traumatol. 2014;15:271-4. https://doi.org/10.1007/s10195-014-0292-0
  16. Patel S, Menendez PB, Hossain FS, et al. Does the DVR® plate restore bony anatomy following distal radius fractures? Ann R Coll Surg Engl. 2014;96:49-54. https://doi.org/10.1308/003588414X13824511650254
  17. Frattini M, Soncini G, Corradi M, Panno B, Tocco S, Pogliacomi F. Complex fractures of the distal radius treated with angular stability plates. Chir Organi Mov. 2009;93:155-62.
  18. Kwak DS, Lee JY, Im JH, Song HJ, Park D. Do volar locking plates fit the volar cortex of the distal radius? J Hand Surg Eur Vol. 2017;42:266-70. https://doi.org/10.1177/1753193416676704