Do "Anatomic" Distal Ulna Plating Systems Fit the Distal Ulna Without Causing Soft Tissue Impingement?
Do "Anatomic" Distal Ulna Plating Systems Fit the Distal Ulna Without Causing Soft Tissue Impingement?
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DOI：
10.1177/1558944720930302
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发表时间：
2022-05-01
期刊：
影响因子：
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通讯作者：
Horwitz, Maxim D.
中科院分区：
文献类型：
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作者：
Shaerf, Daniel A.;Chae, Woo Jin;Horwitz, Maxim D.
背景：由于尺骨关节软骨与尺侧腕伸肌之间的狭窄区域，尺骨远端骨折固定钢板通常会引起刺激，需要取出。本研究定义了钢板应用的安全区域，并确定手腕位置是否影响撞击风险。方法：将4种不同的尺骨远端解剖钢板（Acumed、Medartis、Skeletal Dynamics和Synthes）应用于12具尸体标本。以周向距离和角弧测量安全区域大小。在中性屈伸、旋前和旋后检查撞击。结果：尺骨远端安全地带面积为92度圆弧，周长15mm。Acumed钢板的6个模拟手腕/前臂位置中，ECU撞击发生率为0%，Synthes钢板为22%，Skeletal Dynamics钢板为31%，Medartis钢板为68%。撞击最常见于旋后。撞击ECU的可能性依次显著降低；Medartis b>骨骼动力学>合成> Acumed。结论：ECU肌腱的活动可引起尺侧远端钢板撞击。术中应进行旋后检查。从4个不同的制造商那里得到关于每个钢板的要点：Medartis钢板的轮廓，当放置成尺形时，是强制性的。尖尖钢板受到的冲击最小，但不是为远端骨折设计的。Synthes钢板体积最小，但不适用于近端骨折。与其他尺型钢板相比，骨动力钢板是最通用的，其撞击发生率降低。
Background: Distal ulna fracture fixation plates commonly cause irritation, necessitating removal, due to the narrow area between the ulna articular cartilage and the extensor carpi ulnaris. This study defines the safe zone for plate application and determines whether wrist position affects risk of impingement. Methods: Four different distal ulna anatomic plates (Acumed, Medartis, Skeletal Dynamics, and Synthes) were applied to 12 cadaveric specimens. Safe zone size was measured in circumferential distance and angular arc. Impingement was examined in flexion and extension in neutral, pronation, and supination. Results: The distal ulna safe zone has dimensions of a 92 degrees arc and perimeter circumference of 15 mm. Cumulative extensor carpi ulnaris (ECU) impingement occurred in 0% of the 6 simulated wrist/forearm positions for the Acumed plate, 22% for the Synthes plate, 31% for the Skeletal Dynamics plate, and 68% for the Medartis plate. Impingement was most common in supination. Likelihood of ECU impingement significantly decreased in the following order; Medartis > Skeletal Dynamics > Synthes > Acumed. Conclusion: The ECU tendon's mobility can cause impingement on ulnarly placed distal ulna plates. Intra-operative testing should be performed in supination. Take home points regarding each plate from the 4 different manufacturers: contouring of Medartis plates, when placed ulnarly, is mandatory. The Acumed plate impinged the least but is not designed for far-distal fractures. The Synthes plate is least bulky but not suitable for proximal fractures. The Skeletal Dynamics plate appeared the most versatile with a reduced incidence of impingement compared to other ulnarly based plates.