Therapeutic efficacy of modified locking plate implantation through single minimally invasive volar approach of 15 mm for type B3 distal radius fractures
Objective To explore the therapeutic efficacy of type B3 distal radius fractures treated with modified locking plate implantation through single minimally invasive volar approach of 15 mm.Methods A retrospective case series study was conducted to analyze the clinical data of 14 patients with type B3 distal radius fractures admitted to Wuxi Ninth People's Hospital from February 2021 to January 2024,including 6 males and 8 females,aged 21-78 years[(50.9±15.5)years].The steel plate was inserted first through single minimally invasive volar approach of 15 mm,followed by reduction and temporary fixation of the fractures.Further adjustment of the reduction and final fixation were performed under fluoroscopy.The length of the incision was observed at the end of the surgery and at the last follow-up.The reduction quality of the articular surface was evaluated by CT at postoperative 3 days.The bone healing was observed and the healing time was recorded.The visual analogue scale(VAS)scores before surgery and at 7,14 days after surgery and at the last follow-up were compared.The grip strengths,range of motions of the wrist joint(flexion-extension,pronation-supination and ulnar-radial deviation),and Gartland-Werley wrist scores at 3,6 months after surgery and at the last follow-up were detected.The occurence of postoperative complications was observed.Results All the patients were followed up for 6-34 months[(17.1±5.2)months].The incision length was(20.3±6.9)mm at the end of the surgery and was(19.1±6.3)mm at the last follow-up.As shown in CT scan at postoperative 3 days,excellent reduction of the articular surface was observed in 9 patients,good in 4 and fair in 1,with an excellent and good rate of 92.9％.The fractures were all healed,with the healing time of 5-8 weeks[(5.9±0.6)weeks].At 7,14 days after surgery and at the last follow-up,the VAS scores were 3.0(3.0,4.0)points,3.0(2.0,3.0)points and 0.0(0.0,1.0)points respectively,significantly lower than 5.0(3.8,6.0)points before surgery(P＜0.01),and the VAS scores significantly decreased over time after surgery(P＜0.05).At 3,6 months after surgery and at the last follow-up,the grip strengths[(72.1±5.3)％,(78.9±4.0)％and(82.9±4.8)％respectively],ranges of wrist flexion-extension[(76.6±3.3)°,(80.9±3.6)° and(82.3±3.6)° respectively],ranges of pronation-supination[(159.4±5.7)°,(172.1±6.2)° and(173.9±3.7)° respectively],ranges of ulnar-radial deviation[(35.8±3.9)°,(37.6±4.0)° and(38.3±3.5)° respectively],and Gartland-Werley wrist scores[7.0(2.8,8.0)points,2.0(2.0,4.5)points,2.0(2.0,2.0)points]were all significantly improved compared with the values preoperatively[(63.4±8.0)％,(74.9±5.4)°,(150.6±10.3)°,(32.7±4.9)° and 18.0(16.8,20.0)points respectively](P＜0.05).Moreover,the ranges of wrist motion were significantly improved over time after surgery(P＜0.05),while the grip strengths and Gartland-Werley wrist scores were significantly improved at postoperative 3 and 6 months(P＜0.05).According to their Gartland-Werley wrist scores at the last follow-up,8 patients were rated excellent,5 good,and 1 fair,with an excellent and good rate of 92.9％.There were 2 patients with delayed incision healing,one injury to the palmar cutaneous branch of the median nerve,and one with extensor tendon irritation because of the overlength of the screw.Conclusion Modified locking plate implantation through single minimally invasive volar approach of 15 mm for type B3 distal radius fractures has advantages of small incision,fast bone healing,reduced pain,increased grip strengths and range of motions of the wrist joint,good wrist function recovery,and few complications.
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