关节镜辅助下桡骨远端骨折用锁定钩克氏针技术固定背椎角碎片

Pub Date : 2023-11-07 DOI:10.1055/s-0043-1776115
Mark Ross, Matthew J. White, Nicholas Smith
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引用次数: 0

摘要

背景:桡骨远端骨折伴背尺角碎片(DUC)由于视觉受限和硬件突出的风险,给手术带来了挑战。传统的入路往往导致复位和固定不充分,导致临床结果不理想。技术描述:在这项研究中,我们介绍了一种关节镜辅助下用DUC碎片固定桡骨远端骨折的方法。该技术利用锁定的钩形k形钢丝提供低姿态的背部捕获机制。我们概述了一步一步的手术过程,包括术前计划、掌侧钢板应用和关节镜下DUC碎片复位。患者和方法:我们将该技术应用于一位60岁的女性患者,该患者患有不稳定的桡骨远端关节内骨折和DUC碎片。最初尝试闭合复位,随后进行关节镜辅助复位和使用锁定钩形k针技术进行内固定。结果:我们的技术已经证明了它能够承受早期运动康复方案而不丢失固定物,从而实现早期活动。定制的热塑性夹板佩戴6周,在临床回顾中具有良好的旋前/旋前和手腕屈伸结果。结论:关节镜辅助下的锁定钩形k针固定为精确复位桡骨远端骨折DUC碎片提供了可靠的解决方案。该入路是标准桡骨远端固定系统的补充,提供了一个低姿态的背侧捕获机制,解决了硬件突出的问题,最终改善了临床结果。
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Arthroscopic-assisted Distal Radius Fracture Fixation for Dorsoulnar Corner Fragments Using a Locked, Hooked Kirschner-Wire Technique
Abstract Background: Distal radius fractures with dorso-ulnar corner fragments (DUC) pose a surgical challenge due to limited visualization and the risk of hardware prominence. Traditional approaches often result in inadequate reduction and fixation, leading to suboptimal clinical outcomes. Description of Technique: In this study, we introduce an arthroscopic-assisted approach for the fixation of distal radius fractures with DUC fragments. The technique utilizes locked, hooked K-wires to provide a low-profile dorsal capturing mechanism. We outline the step-by-step procedure, which includes pre-operative planning, volar plate application, and arthroscopic reduction of DUC fragments. Patients and Methods: We applied this technique to a 60-year-old female patient with an unstable intra-articular distal radius fracture and a DUC fragment. Closed reduction was initially attempted, followed by arthroscopic-assisted reduction and internal fixation using the locked, hooked K-wire technique. Results: Our technique has demonstrated its ability to withstand early movement rehabilitation protocols without fixation loss, enabling early mobilization. A custom thermoplastic splint was worn for 6 weeks, with favorable supination/pronation and wrist flexion/extension outcomes at clinical review. Conclusions: Arthroscopic-assisted fixation with locked, hooked K-wires offers a reliable solution for accurately reducing challenging DUC fragments in distal radius fractures. This approach complements standard distal radius fixation systems, providing a low-profile dorsal capturing mechanism and addressing the issue of hardware prominence, ultimately improving clinical outcomes.
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