[New minimally invasive approach for palmar plating in distal radius fractures].
Distal radius fractures are among the most common fractures. Types A3 and C2 make up almost half of these. Volar fixed-angle plate fixation is the gold standard of treatment today. We wanted to minimise the approach to the distal radius through a transverse 2-3 cm incision in the wrist flexor fold, tunnelling beneath the pronator muscle. The operative technique is demonstrated here. 11 patients, averaging 70 years of age, underwent surgery for 7 A3 and 4 C2 type fractures. Average operating time was 50 minutes. Length of admission averaged 2.9 days. Using a visual analogue scale, pain decreased from 6/10 preoperatively to 3/10 on post-op day one and 2/10 on post-op day three. After 6 weeks, flexion and extension averaged 45-0-45°, and radial and ulnar deviation 20-0-20°. Pronation and supination averaged 85-0-85°. Grip strength with manometer averaged 90 % compared to the contralateral side at 6 weeks and 96 % at 3 months. As comparison, from 1 January 2008 until 31 May 2013, we treated 908 patients with distal radius fractures with volar fixed-angle plates through a conventional longitudinal incision of 5-8 cm. The average skin to skin time was 46 minutes, with an average length of admission of 5.6 days. A minimally invasive approach to treat distal radius fractures with volar plate fixation and sparing of the pronator muscle is possible. The initial patients treated with this approach experienced minimal post-operative pain, shorter hospital admissions, and rapid grip strength recovery with almost undisturbed rotational motion.
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Kliniken Sindelfingen, Klinikverbund Südwest.
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Chmielnicki
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Kliniken Sindelfingen, Klinikverbund Südwest.
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Prokop
D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D011885:Radius Fractures / Q000175:diagnosis* / Q000601:surgery*; D014954:Wrist Injuries / Q000175:diagnosis* / Q000601:surgery*