Mack MG, Keim S, Balzer JO, Schwarz W, Hochmuth K, Windolf J, Vogl TJ.
Clinical impact of MRI in acute wrist fractures.
Eur Radiol. 2003 Mar;13(3):612-7. doi: 10.1007/s00330-002-1600-2. Epub 2002 Sep 11.
Abstract/Text
The purpose of this study was to evaluate the clinical impact of MRI in the early diagnosis of wrist trauma. High-resolution MR imaging was performed on a 1.5-T unit (Symphony Quantum, Siemens, Erlangen, Germany) using coronal and axial T1- and T2-weighted fat-saturated turbo-spin-echo sequence via a dedicated wrist coil within a mean of 6.6 days after initial radiographs in 54 patients (56 wrists) with clinical suspicion of wrist fractures and normal plain or indistinct radiographs. Initial radiographs were evaluated independently by two senior radiologists and the hand surgeon without knowledge of the MRI findings. The initial treatment protocol was based on evaluation of plain films and clinical findings by the hand surgeon. Treatment protocol was changed after MRI examination if necessary. In 31 of 56 wrists MRI findings resulted in a change of diagnosis. There were false-positive diagnoses on plain radiographs in nearly one half ( n=25) of the patients. False-negative diagnoses on plain radiographs resulted in 6 cases. Magnetic resonance imaging detected additional injuries of soft tissue in more than one third ( n=20). In 22 of 56 wrists the period of immobilization could be shortened or ended, in 12 of 56 it was prolonged, and in 3 of 56 a surgical intervention was necessary. In 19 wrists MRI had no therapeutic consequences. Our data demonstrate the high clinical impact of MRI in the detection of acute wrist fractures. We recommend MRI of the wrist immediately on the day of trauma if there is clinical suspicion and normal plain radiographs. Accurate diagnosis by MRI examination within the first days following trauma may reduce economic costs due to shortened immobilization time in cases with a suspected fracture but plain radiographs.
齋藤英彦：橈骨遠位端骨折－解剖学的特徴と分類、治療法．整形・災害外科 1989;32:237-248.
日本整形外科学会，日本手外科学会監修， 日本整形外科学会診療ガイドライン委員会，橈骨遠位端骨折診療ガイドライン策定委員会編集：橈骨遠位端骨折診療ガイドライン2017．南江堂，2017.
佐々木 孝：橈骨遠位端骨折の保存的治療―ギプス固定と創外固定の適応―．整形・災害外科 1989; 32: 249-256.
Orbay JL.
The treatment of unstable distal radius fractures with volar fixation.
Hand Surg. 2000 Dec;5(2):103-12. doi: 10.1142/s0218810400000223.
Abstract/Text
Stable internal fixation and early motion has not been routinely available for distal radius fractures. Difficulties with the dorsal approach discourage surgeons from internally fixing the most common fracture types. The introduction of a new volar plate with subchondral support fixation allows the treatment of most distal radius fractures with stable internal fixation and early motion while avoiding the complications inherent in the dorsal approach.
Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K.
Prospective study of distal radius fractures treated with a volar locking plate system.
J Hand Surg Am. 2008 May-Jun;33(5):691-700. doi: 10.1016/j.jhsa.2008.01.024.
Abstract/Text
PURPOSE: To prospectively determine the results of treatment of distal radius fractures with a volar locking plate system with no bone graft and early mobilization.
METHODS: Internal fixation and early mobilization of dorsally displaced, unstable fractures of the distal radius using a volar locking plate system without bone grafting was investigated in a prospective series of 49 fractures in 49 consecutive patients. All patients were allowed to move the wrist joint immediately after surgery. Physical examination at 5 weeks, 3 months, 6 months, and 1 year after the operation were performed. Radiographic parameters on preoperative, postoperative, and 1-year postoperative radiographs were compared. At 1-year review, the final clinical functions were evaluated with the Gartland and Werley functional scoring system, a modified Green and O'Brien system, and the Disabilities of the Arm, Shoulder, and Hand questionnaire.
RESULTS: The average radiographic results at 1 year were 9 degrees of volar tilt; 22 degrees of radial inclination; 1 mm of ulnar variance, and 0 mm of articular incongruity. At 1-year review, an excellent or good result was found according to the system of Gartland and Werley and a modified Green and O'Brien system with scores of 100% and 98%, respectively. The Disabilities of the Arm, Shoulder, and Hand score averaged 6, indicating a high degree of patient satisfaction. There were no cases of infection, complex regional pain syndrome, tendon rupture, tendon irritation, nerve injury, or implant failure.
CONCLUSIONS: The volar locking plate fixation without bone grafting and early mobilization is a safe and effective treatment for dorsally displaced, unstable fractures of the distal radius.
坂野裕昭，天門永春，中島邦晴ほか：不安定型橈骨遠位端骨折に対するHoffmann 2 compact創外固定器によるnon-bridging創外固定術の適応と術後成績．日本手の外科学会雑誌 2001;18:568-573.
Nishiwaki M, Tazaki K, Shimizu H, Ilyas AM.
Prospective study of distal radial fractures treated with an intramedullary nail.
J Bone Joint Surg Am. 2011 Aug 3;93(15):1436-41. doi: 10.2106/JBJS.J.01159.
Abstract/Text
BACKGROUND: Intramedullary nailing for the treatment of unstable distal radial fractures is reported to provide stable fixation with minimal soft-tissue complications, but there is a paucity of data documenting the results of this technique. The purpose of this study was to prospectively determine the functional outcomes of treatment of unstable distal radial fractures with an intramedullary nail.
METHODS: Patients aged fifty years and older with a dorsally displaced unstable distal radial fracture--an extra-articular or simple intra-articular fracture--that was amenable to closed or percutaneous reduction were offered treatment with intramedullary nail fixation (MICRONAIL). Thirty-one patients were enrolled in the study, and twenty-nine patients with a mean age of sixty-seven years (range, fifty-one to eighty-five years) were available for one-year follow-up. According to the AO classification, there was one type-A2, twenty-four type-A3, and four type-C2 distal radial fractures. The patients were evaluated at six weeks, three months, six months, and one year after surgery. Outcome measures included standard radiographic parameters, active wrist range of motion, grip strength, a modified Mayo wrist score, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
RESULTS: At the final one-year follow-up evaluation, the active range of motion of the injured wrist relative to that on the uninjured side averaged 95% of flexion, 95% of extension, 93% of ulnar deviation, 91% of radial deviation, 99% of pronation, and 99% of supination. The mean grip strength was 96% of that on the uninjured side. According to the modified Mayo wrist score, there were twenty excellent and nine good results. The mean DASH score was 4.8 points. The final radiographic measurements demonstrated, on average, 25° of radial inclination, 11° of volar tilt, 10 mm of radial length, and +1 mm of ulnar variance. Loss of reduction occurred in two patients. One patient developed transient superficial radial sensory neuritis, which resolved within two months.
CONCLUSIONS: Intramedullary nailing can be a safe and effective treatment with minimal complications for dorsally displaced unstable extra-articular or simple intra-articular distal radial fractures.
日本整形外科学会，日本手外科学会監修， 日本整形外科学会診療ガイドライン委員会，橈骨遠位端骨折診療ガイドライン策定委員会編集：橈骨遠位端骨折診療ガイドライン2012．南江堂，2012；57-60.
Kiyoshige Y.
Condylar Stabilizing Technique with AO/ASIF Distal Radius Plate for Colles' Fracture Associated with Osteoporosis.
Tech Hand Up Extrem Surg. 2002 Dec;6(4):205-8. doi: 10.1097/00130911-200212000-00009.
Abstract/Text
The author established a new reduction and fixation technique for osteoporotic distal radius fracture with a use of AO/ASIF volar distal radius plate, referring to the condylar plating technique in distal femoral fracture. This technique is performed in three steps. First, distal fixation is through the insertion of buttress pins just beneath the subchondral bone with a convergent angle of 10 degrees to the articular surface under fluoroscopic assistance. Second, the proximal limb of the plate is lined up with the radius shaft so that the fracture is reduced automatically and anatomically. Third, by rotating the proximal limb of the plate ulnarly and lifting up the ulnar border of the articular surface, the fracture is fixed less than the contralateral ulnar variance, to apply an adequate tension on the triangular fibrocartilage complex (TFCC). This method represents a valuable treatment modality for the most frequent types of unstable distal radius in elderly women.
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 Apr;39(4):670-8. doi: 10.1016/j.jhsa.2014.01.006. Epub 2014 Mar 6.
Abstract/Text
PURPOSE: To determine the percentage of AO B3 distal radius fractures that lose reduction after operative fixation and to see whether fracture morphology, patient factors, or fixation methods predict failure. We hypothesized that initial fracture displacement, amount of lunate facet available for fixation, plate position, and screw fixation would be significant risk factors for loss of reduction.
METHODS: A prospective, observational review was conducted of 51 patients (52 fractures) with AO B3 (volar shearing) distal radius fractures treated operatively between January 2007 and June 2012. We reviewed a prospective distal radius registry to determine demographic data, medical comorbidities, and physical examination findings. Radiographs were evaluated for AO classification, loss of reduction, length of volar cortex available for fixation, and adequacy of stabilization of the lunate facet fragment with a volar plate. Preoperative data were compared between patients who maintained radiographic alignment and those with loss of reduction. A multivariate logistic regression analysis was completed to determine significant predictors of loss of reduction.
RESULTS: Volar shearing fractures with separate scaphoid and lunate facet fragments (AO B3.3), preoperative lunate subsidence distance, and length of volar cortex available for fixation were significant predictors for loss of reduction; the latter was significant in multivariate analysis. Plate position and number of screws used to stabilize the lunate facet were not statistically different between groups.
CONCLUSIONS: Patients with AO B3.3 fractures with less than 15 mm of lunate facet available for fixation, or greater than 5 mm of initial lunate subsidence, are at risk for failure even if a volar plate is properly placed. In these cases, we recommend additional fixation to maintain reduction of the small volar lunate facet fracture fragments in the form of plate extensions, pins, wires, suture, wire forms, or mini screws.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL.
Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius.
J Bone Joint Surg Am. 2004 Sep;86(9):1900-8. doi: 10.2106/00004623-200409000-00007.
Abstract/Text
BACKGROUND: The purpose of the present study is to report on a cohort of patients with a volar shearing fracture of the distal end of the radius in whom the unique anatomy of the distal cortical rim of the radius led to failure of support of a volar ulnar lunate facet fracture fragment.
METHODS: Seven patients with a volar shearing fracture of the distal part of the radius who lost fixation of a volar lunate facet fragment with subsequent carpal displacement after open reduction and internal fixation were evaluated at an average of twenty-four months after surgery. One fracture was classified as B3.2 and six were classified as B3.3 according to the AO comprehensive classification system. All seven fractures initially were deemed to have an adequate reduction and internal fixation. Four patients required repeat open reduction and internal fixation, and one underwent a radiocarpal arthrodesis. At the time of the final follow-up, all patients were assessed with regard to their self-reported level of functioning and with use of Sarmiento's modification of the system of Gartland and Werley.
RESULTS: At a mean of two years after the injury, six patients had returned to their previous level of function. The result was considered to be excellent for one patient, good for four, and fair for two. The average wrist extension was 48 degrees, or 75% of that of the uninjured extremity. The average wrist flexion was 37 degrees, or 64% of that of the uninjured extremity. The one patient who underwent radiocarpal arthrodesis had achievement of a solid union. The four patients who underwent repeat internal fixation had maintenance of reduction of the lunate facet fragment. The two patients who declined additional operative intervention had persistent dislocation of the carpus with the volar lunate facet fragment.
CONCLUSIONS: The stability of comminuted fractures of the distal part of the radius with volar fragmentation is determined not only by the reduction of the major fragments but also by the reduction of the small volar lunate fragment. The unique anatomy of this region may prevent standard fixation devices for distal radial fractures from supporting the entire volar surface effectively. It is preferable to recognize the complexity of the injury prior to the initial surgical intervention and to plan accordingly.
川崎恵吉, 稲垣克記, 門馬秀介, 上野幸夫, 前田利雄, 久保和俊. 橈骨遠位端骨折に対する掌側プレート固定術後の掌側亜脱臼－volar lunate facet fragment固定の重要性. 日本手外科学会雑誌 32 (6): 1023-1027, 2016.
片山健, 古田和彦. 橈骨遠位端骨折に対する近位/遠位設置型掌側ロッキングプレートの選択は月状骨窩骨片の大きさで決まる. 骨折. 2017;39(3):504–507.
近藤秀則, 今谷潤也, 森谷史朗, ほか. 橈骨遠位端骨折に合併するvolar marginal rim fragmentの新分類とその治療戦略. 日本手外科学会雑誌. 2018;34(6):963–968.
森谷浩治. 掌側ロッキングプレート固定後に手根骨掌側亜脱臼をきたした橈骨遠位端骨折例の検討. 整形外科. 2019;70(3):213–220.
上野幸夫, 川崎恵吉, 稲垣克記. 月状骨窩背側骨片を伴うC3型橈骨遠位端骨折の矯正損失について. 日本手外科学会雑誌. 2021;37(6):809–813.
