橈骨遠位端関節内粉砕骨折に対するDesmanet変法と掌側ロッキングプレートの併用手術

Combination of Modified Desmanet's Intramedullary Pinning and Volar Locking Plate Fixation for the Comminuted Intra-Articular Fractures of the Distal Radius

　単独の手技では整復位保持が困難な橈骨遠位端関節内粉砕骨折に対してDesmanet変法と掌側ロッキングプレートを併用して手術した6例7手の臨床成績を報告した．臨床評価は斎藤らの評価法に準じて評価しexcellent5手，good2手であった．X線計測でも整復は良好で矯正損失はみられなかった．本法は低侵襲に橈骨遠位端の粉砕した骨片を周辺から固定する手技(fragment-specific fixation)である．最初にDesmanet変法を施行することで整復位をほぼ獲得できるため，安全で繊細な掌側でのプレート手技が可能となることが利点である．

　Purpose：To present the outcomes of comminuted intra-articular fractures of the distal radius in 7 wrists of 6 patients treated by a combination of Desmanet's intramedullary pinning and volar locking plate.　Material and method：These seven wrists were assessed clinically and radiologically 8.6 months postoperatively.　Desmanet's intramedullary pinning was followed by the application of a volar locking plate.　Result：The clinical results were satisfactory.　Five were assessed as excellent and 2 as good according to Saito's demerit point system.　The fractures were well reduced and postoperative correction loss was negligible on X-ray measurement.　Conclusion：This combined procedure was considered to provide a kind of fragment-specific fixation procedure with reduced invasion at the radial and dorso-ulnar sites.　Comminuted intra-articular fractures of the distal radius were well stabilized by this method.　The volar plating technique can be carried out more safely and precisely after completing Desmanet's intramedullary pinning procedure.