L’articulation radio-ulnaire distale nécessite-t-elle d’être fixée lors des ostéosynthèses par plaque palmaire des fractures du radius distal avec instabilité de la radio-ulnaire ? - 27/08/14

Should distal radio-ulnar joint be fixed following volar plate fixation of distal radius fracture with unstable distal radio-ulnar joint?

Doi : 10.1016/j.rcot.2014.02.027

J. Liu ^{^{1
These authors contributed to the work equally and should be regarded as co-first authors.}}, Z. Wu ^{^{1
These authors contributed to the work equally and should be regarded as co-first authors.}}, S. Li ^⁎ , Z. Li, J. Wang, C. Yang, L. Yu, D. Chen
Department of orthopaedics, the Tenth People's hospital of Shanghai, Tongji university, Shanghai trauma and emergency center, 301, Yanchang road, 200072 Shanghai, Chine

^⁎Auteur correspondant.

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Abstract

Background

Distal radio-ulnar joint (DRUJ) instability often accompanies distal radial fractures. The goal of this study was to investigate whether DRUJ should be fixed to prevent recurrent DRUJ instability in distal radius fracture patients with unstable DRUJ following open reduction and volar plate fixation of the radius.

Methods

A retrospective chart review was performed on forty-nine consecutive patients presenting distal radius fracture who were diagnosed with distal radio-ulnar instability after radius fixation with volar plate. Group one consisted of 24 patients whose DRUJs were fixed in neutral for 6 weeks with 1∼2 Kirschner wires (8 cases combined with casting), whereas group two consisted of 25 patients without DRUJ fixation. All patients had radiographic evaluation of their wrist and DRUJ for stabilities and underwent functional evaluation using modified Gartland and Werley demerit scoring system (GW score).

Results

All patients were followed-up for an average of 15 months (12–24 months) after surgery. No significant difference was noted between the two groups with respect to gender, age, fracture types and damage types (no noteworthy medical comorbidities in either group). At the latest follow-up, patients in both groups had comparable grip strength, wrist motion, and visual analogue scale (VAS) and GW scores. Only one patient (2.4%) demonstrated DRUJ chronic instability, but did not require any additional surgery.

Conclusion

The results suggest that in patients with distal radius fractures, fixation of unstable DRUJs in neutral for 6 weeks does not have an advantage over non-fixation.

Level of evidence

III.

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Keywords : Distal radius fracture, Distal radio-ulnar joint, Joint instability, Volarplate, Gartland and Werley demerit scoring system, Visual analogue scale

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.