Mireadeli Abulimiti 1 , QU Wanming 2 , ZHU Tianbo 1 , ZHANG Daoxin 1 , ZHU Xiaokang 1 , LI Xinzhi 1,3 , CHEN Wenyao 1
  • 1. Department of Orthopaedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang Hubei, 443001, P. R. China;
  • 2. Department of Orthopaedics, Yiling People’s Hospital of Yichang City, Yichang Hubei, 443100, P. R. China;
  • 3. College of Medical and Health Sciences, China Three Gorges University, Yichang Hubei, 443002, P. R. China;
LI Xinzhi, Email: lixpj@163.com; CHEN Wenyao, Email: yc117193@163.com
Distal radius fracture; metacarpal margin; tension band assisted fixation
10.7507/1002-1892.202503049
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Objective  To investigate the surgical technique and effectiveness of tension band-assisted plate and external fixator fixation for volar marginal fractures of the distal radius. Methods  A retrospective analysis was performed on the clinical data of 12 patients with volar marginal fractures of the distal radius treated by Kirschner wire tension band-assisted anatomical plate and external fixator fixation between October 2018 and July 2023. There were 9 males and 3 females, aged from 20 to 52 years (mean, 35.5 years). The injury causes included traffic accidents in 6 cases, falls from height in 3 cases, and falling down in 3 cases. According to AO/Orthopaedic Trauma Association (AO/OTA), there were 1 case of type B2, 4 cases of type B3, 2 cases of type C1, 3 cases of type C2, and 2 cases of type C3. According to Fernandez classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ, and 5 cases of type Ⅴ. Associated injuries included radiocarpal joint dislocation or subluxation in 7 cases and median nerve injury in 2 cases. The time from injury to operation was 2-7 days (mean, 3.2 days). Postoperatively, functional outcomes were evaluated using the modified Mayo wrist score and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Grip strength was measured as the ratio to the unaffected side, and wrist range of motion (ROM) including dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was assessed. Results  All surgeries were successfully completed, with an operation time of 55-110 minutes (mean, 65 minutes). All patients were followed up 6-36 months (mean, 13.7 months). Surgical incisions healed by first intention, without complications such as vascular-nerve injury or infection. Bony union and articular congruency were attained in all patients, with a healing time of 3-5 months (mean, 3.8 months). During follow-up, 1 case of Kirschner wire back-out irritation was noted, while no infections, radiocarpal dislocations, internal fixation failures, or extensor pollicis longus tendon ruptures occurred. At last follow-up, the modified Mayo wrist score ranged from 65 to 92 (mean, 80.8), the DASH score from 7 to 15 (mean, 11.6), grip strength was 65%-90% (mean, 78.2%) of the unaffected side; and wrist ROM was palmar flexion 60°-85° (mean, 77.4°), dorsiflexion 55°-80° (mean, 74.8°), radial deviation 10°-25° (mean, 18.8°), and ulnar deviation 15°-30° (mean, 24.5°). Conclusion  Kirschner wire tension band-assisted anatomical plate and external fixator fixation for volar marginal fractures of the distal radius is a simple method with reliable fixation, which can achieve satisfactory effectiveness.

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