跨腕关节钢板与外固定支架治疗桡骨远端粉碎骨折的疗效比较

目的 比较跨腕关节钢板与外固定支架治疗桡骨远端粉碎骨折的疗效.方法 2007年3月至2010年4月采用跨腕关节钢板(钢板组)和外固定支架(外固定支架组)治疗57例桡骨远端粉碎骨折患者.其中钢板组28例,男18例,女10例;年龄21～67岁,平均44.7岁;左侧17例,右侧11例;C2型8例,C3型20例.外固定支架组29例,男19例,女10例;年龄21～69岁,平均49.4岁;左侧12例,右侧17例;C2型13例,C3型16例.对两组患者术中及住院期间的各项指标、术前与术后的影像学结果、临床疗效结果及并发症进行对比分析.结果 57例患者术后获12～35个月(平均24.4个月)随访.钢板组较外固定支架组手术时间长、术中出血量多、切口长度相对较长,两组比较差异均有统计学意义(P＜0.05).两组患者掌倾角、尺偏角、桡骨茎突长度在术前、术后及随访时比较差异无统计学意义(P＞0.05).两组患者关节面台阶术前、术后2 d比较差异无统计学意义(P＞0.05),术后12个月随访比较差异有统计学意义(P＜0.05).两组患者术后6个月、末次随访时旋前、旋后、掌屈、背伸活动范围比较,差异均无统计学意义(P＞0.05).根据Jakim评分标准,钢板组优于外固定支架组,但两组比较差异无统计学意义(P＞0.05).外固定支架组并发症发生率显著高于钢板组,两组比较差异有统计学意义(P＜0.05).结论 跨腕关节钢板与外固定支架治疗桡骨远端粉碎骨折,复位和治疗效果相当,跨腕关节钢板创伤较大,但复位稳定性好,并发症较少.     

桡骨远端C3型骨折不同治疗方法的回顾性研究

目的探讨C3型桡骨远端骨折有效治疗方法。方法对2017年6月-2018年7月收治的53例桡骨远端C3型骨折患者,分别采用闭合复位外固定架固定和切开复位锁定加压钢板内固定两种方法进行固定,其中外固定架组34例,内固定组19例,并按照两种治疗方法的复位标准和功能标准对优良率进行比较。结果53例术后均获得随访,随访时间19~36个月,平均28个月。按Gartland和Werley腕关节功能评估标准进行评定,外固定架固定组优良率88.2%,内固定组优良率88.8%。两组在尺偏角和桡骨高度方面差异无统计学意义(P>0.05),外固定架组掌倾角小于内固定组,两组差异有统计学意义(P <0.05)。结论切开复位锁定加压钢板内固定与闭合复位外固定架固定效果无明显差异,外固定架在治疗桡骨远端C3型骨折的应用上占有一席之地。     

老年不稳定桡骨远端骨折3种外固定方式治疗后桡腕关节解剖参数及腕关节功能分析

目的分析石膏、夹板与外固定架固定治疗老年不稳定桡骨远端骨折后桡腕关节解剖参数及腕关节功能恢复情况。方法纳入120例老年不稳定桡骨远端骨折,手法复位后石膏外固定40例(石膏组),手法复位后夹板外固定40例(夹板组),手法复位后外固定架固定40例(外固定架组)。结果 120例均获得4~8(6.15±1.76)个月随访。石膏组与外固定架组关节面丢失、桡骨轴向短缩程度较夹板组轻,差异有统计学意义(P0.05);但石膏组与外固定架组关节面丢失、桡骨轴向缩短长度比较差异无统计学意义(P0.05)。石膏组腕关节功能Gartland-Werley评分优良率高于夹板组和外固定架组,且外固定架组评分优良率高于夹板组,差异有统计学意义(P0.05)。结论石膏与外固定架固定治疗老年不稳定桡骨远端骨折对桡腕关节平整度和桡骨长度恢复影响较小,且石膏固定患者腕关节功能恢复更佳。     

掌侧锁定钢板联合外固定架固定治疗陈旧性骨质疏松性桡骨远端骨折

目的探讨掌侧锁定钢板联合外固定架固定治疗陈旧性骨质疏松性桡骨远端骨折的临床疗效。方法回顾性分析自2015-01—2018-06采用掌侧锁定钢板内固定联合桡侧外固定架固定治疗的22例陈旧性骨质疏松性桡骨远端骨折,比较术前与术后12个月桡骨远端掌倾角、桡骨远端尺偏角、屈曲活动度、背伸活动度、腕关节旋前、旋后角度。结果22例均顺利完成手术并获得至少12个月随访,随访时间12~18个月,平均14.7个月。术后切口愈合良好,未出现感染等并发症,未出现螺钉松动及内固定断裂、内固定移位、骨折断端再移位等并发症。术后12个月Gartland-Werley腕关节功能等级:优4例,良14例,可3例,差1例。术后12个月桡骨远端掌倾角、桡骨远端尺偏角、屈曲活动度、背伸活动度、腕关节旋前、旋后角度较术前均明显改善,差异有统计学意义(P<0.05)。结论掌侧锁定钢板内固定联合桡侧外固定架手术治疗骨质疏松性桡骨远端陈旧骨折能较好地复位固定骨折断端,提高了固定强度,促进了骨折愈合,可避免桡骨短缩及骨折移位,改善腕关节功能,临床效果满意。     

单纯锁定钢板与钢板联合外固定架治疗桡骨远端复杂关节内骨折的疗效比较

目的比较单纯锁定钢板内固定和钢板内固定联合外固定架治疗桡骨远端复杂关节内骨折的临床疗效。方法回顾性分析自2010-01—2013-08行手术治疗的38例桡骨远端复杂关节内骨折。单纯采用锁定钢板内固定23例(单纯组),采用锁定钢板内固定联合外固定架治疗15例(联合组)。比较2组手术相关指标、影像学指标、腕关节功能评分。结果单纯组切口总长度短于联合组,联合组桡骨高度、掌倾角恢复程度优于单纯组,差异有统计学意义(P0.05);2组手术时间、术后当天VAS评分、尺倾角、关节面台阶差异无统计学意义(P0.05)。术后1年Mayo腕关节功能评分中,联合组总分、活动度、握力、功能高于单纯组,差异有统计学意义(P0.05);但2组疼痛评分差异无统计学意义(P0.05)。单纯组发生关节炎4例,联合组发生关节炎3例,2组关节炎发生率比较差异无统计学意义(χ2=0.041,P0.05)。结论上述2种方法治疗桡骨远端复杂关节内骨折均能有效复位,恢复关节功能。钢板内固定联合外固定架固定复位效果更好,术后1年腕关节功能更优,但有钉道感染风险。     

切开复位锁定加压钢板内固定与闭合复位外固定支架固定治疗桡骨远端骨折的比较

目的比较切开复位锁定加压钢板内固定与闭合复位外固定支架固定治疗桡骨远端骨折的疗效与安全性。方法选取2012年1月至2016年1月于我院接受治疗桡骨远端骨折的62例患者为研究对象,其中30例采用的是切开复位锁定加压钢板内固定,其余32例则采用闭合复位外固定支架固定。回顾性分析比较两组患者的手术情况、骨折愈合时间以及术后不同时间的腕关节主动活动度。结果内固定组患者的术中出血量和手术时间均多于外固定组(P<0.05),但两组患者的并发症发生率差异无统计学意义(P>0.05);内固定组患者的骨折愈合时间长于外固定组(P<0.05);内固定组患者的腕关节主动活动度在术后3个月时小于外固定组(P<0.05),但两组患者在术后1年后的腕关节主动活动度差异无统计学意义(P>0.05)。结论两种治疗方法对桡骨远端骨折均具有较高的疗效与安全性,但是闭合复位外固定支架固定的疗效更为显著,且避免了二次手术,值得临床推广应用。     

三种方法治疗桡骨远端粉碎性骨折的临床疗效对比观察

目的：评价3种不同方法治疗桡骨远端粉碎性骨折后的临床疗效。方法本院收治桡骨远端粉碎性骨折78例，根据治疗方法不同随机平分3组，分别行保守治疗、外固定支架治疗，解剖锁定钢板内固定治疗。术后观察骨折愈合情况，患肢掌倾角、尺偏角和桡骨高度等临床指标。采用Sarmiento系统行骨折复位效果评估，采用Dienst标准评估术后腕关节功能恢复情况。结果 C组手术时间长于A、B两组，比较具有统计学意义（P＜0.05）。C组治疗后Sarmiento复位评估、Dienst腕关节功能评估、尺偏角、掌倾角、桡骨高度恢复均优于A、B两组，比较具有统计学意义（P＜0.05），B组治疗后Sarmiento复位评估、Dienst腕关节功能评估、尺偏角、掌倾角、桡骨高度恢复均优于A组，比较具有统计学意义（P＜0.05）。C组治疗后并发症发生率少于A、B两组，比较具有统计学意义，（P＜0.05）。结论3种方法治疗桡骨远端粉碎性骨折后手术及骨愈合时间无明显差异，但解剖锁定钢板内固定治疗后桡骨远端骨性解剖结构恢复最好，腕关节功能恢复优于其他两种方法。     

动力跨关节型外固定架在不稳定性桡骨远端骨折中的应用

目的 探讨手法复位或辅以有限内固定结合动力跨关节型外固定架跨腕关节固定治疗不稳定性桡骨远端骨折的效果.方法 应用手法复位或辅以内固定结合动力跨关节型外固定架跨腕关节固定治疗35例不稳定性桡骨远端骨折,骨折愈合后拆除外固定架.结果 随访6～16个月,骨折愈合时间7～9周.最后一次随访时,按Cooney腕关节评分系统(包括疼痛、功能状况、腕关节活动度、握力):优18例,良14例,可1例,优良率为91.4%.结论 手法复位或辅以有限内固定结合动力跨关节型外固定架跨腕关节固定治疗桡骨远端骨折既能使骨折复位、固定满意,又有利于术后早期手和腕部的功能康复锻炼,是治疗不稳定性桡骨远端骨折的有效方法.     

外固定支架与微创掌侧锁定钢板治疗桡骨远端骨折疗效比较

目的探讨外固定支架与微创掌侧锁定钢板治疗桡骨远端骨折的临床疗效。方法将82例桡骨远端骨折患者随机分为外固定架组(41例,采用外固定支架治疗)和掌侧钢板组(41例,采用掌侧锁定钢板内固定治疗)。比较两组患者的手术情况、腕关节功能及并发症情况;影像学检查评价两组术后骨折恢复情况。结果掌侧钢板组手术时间长于外固定架组(P0.05),术中出血量、住院时间及骨折愈合时间两组比较差异均无统计学意义(P0.05)。患者均获得随访,时间16～18个月。术后12个月,掌侧钢板组的腕关节功能评分及优良率均高于外固定架组(P0.05),尺偏角、掌倾角及桡骨高度均优于外固定架组(P0.05)。外固定架组发生针道感染3例,肌腱损伤1例,桡神经浅支激惹3例;掌侧钢板组发生屈肌腱损伤3例,腕管综合征2例;两组并发症发生率比较差异无统计学意义(P0.05)。结论外固定支架与微创掌侧锁定钢板治疗桡骨远端骨折均可获得满意的疗效,前者手术用时短,后者对腕关节功能的改善效果更好。     

动力跨关节型外固定架治疗不稳定性桡骨远端骨折

[目的]探讨手法复位或辅以有限内固定结合动力跨关节型外固定架跨腕关节固定治疗不稳定性桡骨远端骨折的效果.[方法]应用手法复位或辅以内固定结合动力跨关节型外固定架跨腕关节固定治疗65例不稳定性桡骨远端骨折,骨折愈合后拆除外固定架.[结果]随访6～16个月,骨折愈合时间7～9周.最后一次随访时,按Cooney腕关节评分系统(包括疼痛、功能状况、腕关节活动度、握力):优40例,良21例,可2例,差2例,优良率为93.8%.[结论]手法复位或辅以有限内固定结合动力跨关节型外固定架跨腕关节固定治疗桡骨远端骨折既能使骨折复位、固定满意,又有利于术后早期手和腕部的功能康复锻炼,是治疗不稳定性桡骨远端骨折的有效方法.     

锁定加压接骨板与外固定支架治疗桡骨远端粉碎性骨折的疗效比较

目的 比较锁定加压接骨板与外固定支架治疗桡骨远端粉碎性骨折的临床疗效.方法 对40例桡骨远端粉碎性骨折患者,采用掌侧锁定加压接骨板和外固定支架治疗;其中21例行掌侧锁定加压接骨板,19例行外固定支架.按AO/ASIF分型:C1型10例,C2型15例,C3型15例.随访内容包括测量腕关节活动度,前臂旋转活动度,握力、捏力及相关影像学资料(掌倾角、尺偏角、桡骨高度).按上肢功能评定标准(Disabilities of the Arm,Shoulder and Hand,DASH)和Gartland-Werley腕关节评分标准进行综合评估.对随访数据进行统计学分析,比较两组的治疗效果.结果 术后随访时间为6～48个月,平均18.8个月.根据Gartland-Werley腕关节评分标准评定,锁定加压接骨板治疗组优良率为81.0%,外固定支架治疗组优良率为78.9%.两组在掌曲、背伸、桡偏、旋前、旋后、握力、捏力、掌倾角、尺偏角、桡骨高度等方面,Gartland-Werley腕关节评分和DASH值差异均无统计学意义(P＞0.05);锁定接骨板组的腕尺偏活动度小于外固定支架组,差异有统计学意义(P＜0.05).锁定接骨板治疗组中无并发症出现.外固定支架治疗组中1例反射性交感神经营养不良症,药物治疗和理疗后好转;1例钉道感染,局部换药后治愈.结论 采用掌侧锁定加压接骨板和外固定支架治疗桡骨远端粉碎性骨折具有相同效果,具体可根据骨折类型、患者的功能要求及经济情况选择手术方案.

Abstract：

Objective To compare the treatment outcomes between locking compression plate and external fixator for treating severely comminuted distal radius fracture. Methods Forty patients of severely comminuted distal radius fractures were treated with either locking compression plate fixation via a volar approach or external fixator. Twenty-one patients were treated with locking compression plate fixation, while the other 19 patients were treated with external fixator. According to AO/ASIF classification, there were 10 type C1 fractures,15 type C2 fractures and 15 type C3 fractures.Wrist range of motion, forearm range of motion, grip and pinch strength, radiographic data (palmar tilt, radial inclination, radial height), scores by the Disabilities of the Arm,Shoulder and Hand (DASH) and by Gartland-Werley were collected at follow-up. The data were statistically analyzed to compare the clinical effects. Results Postoperative follow-up ranged from 6 to 48 months with an average of 18.8 months. According to Gartland-Werley wrist score, the excellent and good rate was 81.0% in the locking compression plate group, and 78.9% in the external fixator group. No significantly difference was detected in the ROM of flexion, extension, radial deviation, pronation, supination, grip and pinch strength, the parameter of palmar inclination, ulnar inclination and radial height and in Gartland-Werley score and DASH score between the two groups (P＞0.05). The ROM of unlar deviation in the locking compression plate group was significantly smaller than that in the external fixation group ( P＜0.05). No complication occurred in the locking compression plate group. One patient developed sympathetic reflex dystrophy postoperatively in the external fixation group. After medication and physical therapy the symptoms had resolved. Infection of the external fixator pin tract was note in another patient which was effectively treated by wound care. Conclusion Locking compression plate and external fixator lead to siunilar treatment outcomes for severely cormminuted distal radius fractures. Patient's functional requirement, age and financial status should be taken into consideration while choosing one of these procedures.     

Internal distraction plating of distal radius fractures

Internal distraction plating can be used for the treatment of highly comminuted distal radius fractures especially in elderly patients. The technique involves the use of 3.5, 2.7, or 2.5 dynamic compression plates. The instrumentation is applied in distraction dorsally from the radial diaphysis, bypassing the comminuted segment, and fixed distally to the long metacarpal. The advantages of this technique are: a) it can be used as an alternative for managing difficult fractures in the elderly population; b) it is indicated in patients with osteoporotic bone; c) complications associated with external pins are avoided; and d) the stability of the plate allows patients to use the extremity for transfer and activities of daily living. On the other hand, possible disadvantages to be considered are: a) the need of a second operation to remove the plate; and b) the prolonged duration of immobilization. Elderly patients with osteoporotic bone who undergo treatment of comminuted distal radius fractures may result in poor outcomes with high rates of complications if external fixation or standard internal fixation is used. The current approach represents an alternative that provides union of the fracture with excellent alignment, functional range of motion, and minimal functional disability.     

掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的疗效比较

目的比较掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的临床疗效。方法回顾性分析自2015-01—2018-03诊治的78例不稳定桡骨远端关节内骨折,47例采用掌侧锁定接骨板固定手术治疗(锁定板组),31例采用外固定架手术治疗(外固定组)。比较2组手术时间、并发症情况,以及末次随访时关节塌陷情况、DASH评分、Gartland-Werley评分、握力、屈曲度、背伸度、旋前度、旋后度、桡侧倾斜度、尺侧倾斜度。结果 78例均顺利完成手术,随访时间12~32个月,平均16.2个月。锁定板组手术时间较外固定组长,差异有统计学意义(P<0.05)。2组并发症情况比较差异无统计学意义(P>0.05)。末次随访时2组DASH评分、Gartland-Werley评分、握力、腕关节背伸度、旋后度、桡侧倾斜度以及尺侧倾斜度比较差异无统计学意义(P>0.05);锁定板组在屈曲度、旋前度表现较外固定组更好,关节塌陷数较外固定组少,差异有统计学意义(P<0.05)。结论掌侧锁定接骨板手术治疗不稳定性桡骨远端关节内骨折能更好地恢复腕关节的屈曲和旋前功能,维持关节面平整性,但并不能减少并发症以及获得更好的功能评分;医师应综合考虑骨折分型、关节面塌陷以及患者的需求,选择合适的手术方法。     

A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures

Purpose: Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment. This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation. Methods: A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups: volar plate group and external fixator group. These patients aged between 18 and 60 years had unilateral fractures, and agreed to be included in the study. Patients with a history of fracture, bilateral fracture, associated other injuries, delayed injury for more than 2 weeks, open fracture, pre-existing arthrosis or disability, psychiatric illness and pathological fracture were excluded. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The assessment of pain, functional activity, range of motion and grip strength was done at each stage of follow-up. The pain and functional activities were assessed by patient rated wrist evaluation (PRWE) score and disabilities of the arm, shoulder and hand (DASH) score. Results: Patients in volar plate group had superior PRWE score and DASH score at each stage of followup. At 1 year follow-up, the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group; while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group. They had better flexion and extension range of movement. They also had better pronation and supination range of motion at initial follow-up, however the difference get attenuated by 1 year. Volar plate group had significantly better grip strength than external fixator group. Complication rates were higher in external fixation group. Conclusion: Fixation with variable angle volar plate results in early wrist mobilization, better range of movement, less pain and disability and early return of function.     

肱骨干骨折髓内外固定的生物力学研究

目的 通过对单一加压钢板螺钉加髓内针、交锁髓内钉和微创技术简单有限内固定加单臂外支架3种不同固定方法治疗肱骨干复杂骨折的生物力学性能进行对比研究,为临床应用提供可靠的生物力学依据.方法 取自愿捐赠的18个新鲜湿润肱骨标本,制备肱骨干复杂骨折模型,根据不同固定方式随机分为3组,每组6个.钢板组:采用单一加压钢板螺钉加髓内针固定;髓内钉组:采用交锁髓内钉固定;外支架组:采用微创技术简单有限内固定加单臂外支架固定.分别进行轴向压缩实验和水平扭转实验.结果 轴向压缩实验:各组载荷-位移曲线呈线性到非线性变化.钢板组及髓内钉组最大载荷值分别为(6162.09±521.06)N和(6738.32±525.89)N,两组比较差异无统计学意义(P>0.05);外支架组最大载荷值为(2753.57±185.59)N,与其余两组比较,差异均有统计学意义(P<0.05).钢板组及外支架组刚度值分别为(171.69±6.49)N/mm和(132.59±2.93)N/mm,两组比较差异无统计学意义(P>0.05);髓内钉组的刚度值为(333.04±36.85)N/mm,与其余两组比较差异有统计学意义(P<0.05).水平扭转实验:各组扭矩-扭角曲线呈线性到非线性变化.髓内钉组和外支架组的最大扭矩分别为(17.12±5.73)Nm和(20.26±6.42)Nm,两组比较差异无统计学意义(P>0.05);钢板组的最大扭矩为(38.24±7.08)Nm,与其余两组比较差异有统计学意义(P<0.05).钢板组及外支架组刚度值分别为(16.36±2.07)Ncm/°和(18.79±2.62)Ncm/°,差异无统计学意义(P>0.05);髓内钉组的刚度值为(11.45±0.22)Ncm/°,与其余两组比较差异有统计学意义(P<0.05).结论 钢板组压缩和扭转强度均较强,旋转刚度较强而压缩刚度较弱;髓内钉组压缩强度和压缩刚度较强,而扭转强度和扭转刚度较弱;外支架组仅在扭转刚度上与钢板组相当,而在其他3项指标上均较弱.     

桡骨远端C型骨折掌侧锁定钢板与外固定架的疗效比较

目的比较掌侧锁定钢板与外固定架治疗桡骨远端C型骨折的疗效。方法采用随机对照法,纳入2014年10月到2017年10月收治的桡骨远端C型骨折患者,随机分为两组,分别采用外固定架或者掌侧锁定钢板治疗。比较两组患者手术时间、术中出血量、骨折愈合时间、术后并发症发生率;比较末次随访时患者腕关节活动度、桡骨掌倾角、尺偏角;比较健、患侧握力比值和患侧腕关节Gartland-Werley评分。结果共纳入30例患者,其中外固定架组14例,掌侧锁定钢板组16例。两组患者术后均随访1年。结果显示,掌侧锁定钢板组手术时间长于外固定架组,术中出血量多于外固定架组,但末次随访时桡骨掌倾角、尺偏角恢复水平优于外固定架组(P<0.05);两组骨折愈合时间,末次随访时腕关节屈伸、旋转活动度,健、患侧握力比,患侧腕关节Gartland-Werley评分等,均未见明显统计学差异(P>0.05);两组患者均未发生术后并发症。结论对于桡骨远端C型骨折,外固定架治疗的手术风险小于掌侧锁定钢板,但会造成术后一定程度的复位丢失,然而这种复位丢失并不影响患者的腕关节功能恢复。     

Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures

IntroductionDistal radius fractures are the most frequent upper limb injuries encountered by orthopedic surgeons. Surgical treatment of distal radius fractures is preserved for unstable and displaced fractures. A randomized controlled trial was conducted to compare the radiological and functional outcomes of bridge plating (BP) to external fixation (EF) in comminuted intra-articular distal radius fractures.MethodsSixty patients with distal radius fractures were eligible for treatment by means of ligamentotaxis using either a dorsal bridge plate (30 patients) or an external fixator (30 patients) with or without supplementary Kirschner wires (K-wires). Radiological evaluation was done using the radial inclination angle, radial length, and the volar tilt. Clinical evaluation was performed using ranges of wrist motion, grip strength, Visual Analogue Scale (VAS), and a validated Arabic version of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaireResultsPatients were followed up for 12 months. No significant difference was found in terms of radiographic parameters or ranges of wrist motion. At 3-months follow-up, bridge plating group had stronger grip strength, lower Disability of the Arm, Shoulder, and Hand scores, and lower Visual Analogue Scale. However, both groups had similar functional outcomes at last follow-up. External fixation group had a higher rate of postoperative complications.ConclusionIn comparison to external fixation, bridge plating may provide earlier functional recovery with lower complication rates. However, no functional or radiological superiority were demonstrated at 12-months follow-up.     

Is there a place for external fixation in humeral shaft fractures?

There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.