Article

Appropriate treatment for fractures of the distal radius with dorsal displacement
remains a subject of debate. Intrafocal pinning is the most widely used technique
in France. Plate fixation has been developed to avoid secondary displacement and
stiffness sometimes observed after pinning. We compared three osteosynthesis
techniques for the same type of fracture (extra-articular with dorsal
displacement). Sixty-two consecutive patients underwent osteosynthesis using the
following techniques successively: posterior plates
(20 patients mean age 59.9
years [range 25-87 years]), intra- and extrafocal pinning (22 patients mean age
55.6 years [range 17-83 years]), the anterior plate (20 patients mean age 57.1
years [range 17-78 years]). An independent operator evaluated all patients using
the Herzberg, Gartland and Werley and Dash scores. The radial slope in the
frontal plane, sagittal tilt, and ulnar variance were measured and compared
between the preoperative and last follow-up values. Kruskall-Wallis or ANOVA were
applied as appropriate for continuous variables and the Chi-square test for
non-continuous variables. P<0.05 was considered significant. Mean operative time
was equivalent for the two plates fixation techniques and twice as long as for
pinning. There were more complications in the posterior plating group (32%) and
less satisfactory function score despite a two-fold longer follow-up and a
smaller number of operators. The best results were obtained with the anterior
plating group in terms of range of motion (flexion-extension), DASH score,
preservation of ulnar variance and presence of a largest number of excellent and
very good outcomes according to Gartland. The pinning group provided the best
results in terms of sagittal slope. The pinning and anterior plating groups had
equivalent range of motion for pronation-supination and the same rate of
complications (5%). Irrespective of the treatment arm, the Herzberg scores and
the Gartland and Dash scores were better: in men, in patients aged less than 30
years, in patients with an associated fracture of the apex of the ulnar syloid
process rather than its base. For these extra-articular fractures, pinning can
provide good functional results like anterior plating but each treatment has
advantages that functional analysis detected.
CI - Copyright (c) 2010. Published by Elsevier SAS.

Langue : FRANCAIS