Winkelstabile Plattensysteme am distalen Radius: Lösungsmöglichkeiten und Probleme1

Vermei-Abstract Fractures of the distal radius are most common in adults. Insufficient results following conservative treatment lead to a change of paradigm: during the mid-nineties of the last century the operative procedures like percutaneous K-wiring, external fixation systems and plating with conventional 3.5 mm plate systems became extended by the invention of plate systems with head locking screws, angular stable plate systems. Meanwhile the results after palmar plating with systems in a dimension of 2.4– 3.5 mm of even extension fractures of the distal radius are so encouraging that this treatment has become a standard procedure. Only wide displaced fractures type C2 or C3 sometimes need to be addressed from dorsally. The results of 244 extension fractures of the distal radius using palmar approach in plating with three different plate systems are presented. Fracture type and patients data were comparable in all 3 groups. The functional outcome of regular vs. 3.5 mm plates with headlocking screws (LCP) showed similar results. The best outcome with statistical relevance could be created by the use of the 2.4/2.7 mm plate system (Synthes ® ). Some technical hints have to be regarded to obtain good radiological and functional results: the head locking screws in the distal fragment have to be placed subchondrally and the tips of these screws may not overtop the dorsal cortex. Thus complications like irritation of extension tendons, additional bone grafting even in osteoporotic bone or loss of reduction postoperatively become very rare. Functional treatment postoperatively reduced the rate of reflex sympathic dystrophy syndrome dramatically.