Fractures of the distal radius treated with a nonbridging external fixation technique using multiplanar k-wires

PURPOSE: Joint-bridging external fixation is a minimally invasive treatment option for distal radius fractures. Although radial length can be restored easily the anatomic reduction of articular fragments and restoration of the normal volar tilt proves to be more difficult. A method of nonbridging hybrid fixation of distal radius fractures facilitates fracture reduction and allows for free wrist movement. METHODS: Twenty-five consecutive patients with fractures of the distal radius were treated with nonbridging external fixation for 6 weeks. The stepwise surgical technique comprised a preliminary joint-bridging construction for reduction purposes, the subsequent insertion of 3 to 4 K-wires in the distal fragment, the assembling of wires to a bar nearly parallel to the fracture line, and lastly the removal of the joint-bridging part. Clinical and radiologic evaluation was performed on the first and seventh days and at 6 weeks and 2 years after surgery. RESULTS: All fractures united. Palmar tilt (> or =0 degrees ) and articular surface (articular step-off < 2 mm) were restored in all patients whereas loss of radial length occurred in 4 patients having the distal fracture fragment secured with 3 K-wires. No radial shortening was seen in fractures with 4 K-wires inserted in the distal fragment. Functional results at 2 years after surgery showed an average extension of 55 degrees and flexion of 64 degrees without significant differences between extra-articular and intra-articular fractures. There was no extensor tendinitis or pin loosening in the distal fragment; however, 3 pin track infections of proximal pins occurred. CONCLUSIONS: This surgical technique of nonbridging external fixation is a good treatment option for distal radius fractures: it permits wrist movement. We recommend the insertion of 4 K-wires in the distal fracture fragment.     

Arthroscopic-assisted reduction of distal radius fractures

The outcomes of seven patients with severe comminuted intraarticular fractures of the distal radius treated by arthroscopic reduction and percutaneous external fixation (ARPEF) were retrospectively reviewed. All of the fractures were classified as C3 types using the AO classification scheme. Outcomes were evaluated using the Gartland and Werley functional criteria, an objective wrist examination a radiographic analysis, and a self-assessment outcome form at an average follow-up of 27 months (range, 12 to 45 months). All patients were free of pain and had returned to their prior occupations. No patient had articular incongruency of greater than 1 mm, and there was no evidence of radiocarpal degenerative change. Active range of motion and maximal grip strength averaged 92% and 98%, respectively, of the uninjured wrist. The technique of arthroscope-assisted reduction and percutaneous external fixation yielded excellent results in a small group of patients, with minimal complications.     

非角度稳定性钢板固定治疗桡骨远端关节内背侧移位骨折的结果

Objective Intra-articular fractures of the distal radius in young adults comprise a distinet fracture pattern that is diffficuh to manage and associated with a high frequency of post-traumatic arthritis.Restoration of articular congruency and alignment should improve the outcome.Methods In this study we prospectively re- viewed the results of 21 consecutive cases of dorsally displaced intra-articular distal radius fractures which were treated with internal fixation after failing to achieve articular congruency with closed reduction.Results 3 patients were lost to follow-up.For the rest of 18 patients,follow-up time ranges from 18 to 75 weeks the fractures had healed with highly satisfactory radiographic and functional results.The final volar tilt averaged 4.9°;radial inclination 23.9°;radial length 14mm;and articular incongruity,0.1 mm.Wrist motion at final follow-up examination aver- aged flexion 62°,extension 60°,radial deviation 16°,ulnar deviation 27°,pronation 77°and supination 74°.Grip strength averaged 83% of the uninjured side.The overall outcome of 18 patients(94.4%)had a good or excellent result according to the system of Gartland and Werley and 18 patients(72.2%)had a good result according to the modified system of Green and O'Brien at the most recent evaluation.The only complication in this series was a superficial pin tract infection,which was rapidly resolved with removal of pins at 5th week of external fixation. Conclusion Thus restoration of articular congruency and alignment is possible with minimal complication using modern non-angular stable methods of internal fixation.     

Corrective osteotomy of malunited distal radius fractures using carbonated hydroxyapatite as an alternative to autogenous bone grafting

PURPOSE: The purpose of the present study was to report on the author's experience using carbonated hydroxyapatite as a bony substitute in distal radius corrective osteotomies. METHODS: Six patients had a corrective osteotomy for a malunited distal radius fracture using carbonated hydroxyapatite as an alternative to an autogenous bone graft. Internal fixation of the osteotomy was achieved by using 2 or 3 K-wires. RESULTS: At an average follow-up evaluation of 33 months (range, 22-45 mo) all the osteotomies united. Wrist flexion-extension motion improved from 75 degrees to 110 degrees , forearm rotation increased from 116 degrees to 157 degrees , and grip strength had an average increase of 140% at the time of the final follow-up evaluation. All patients were satisfied and there were no reports of persistent pain. Radiographic evaluation showed an average volar tilt improvement from a preoperative dorsal angulation shifting into a neutral position in the sagittal plane; radial lengthening improved from an average of 4 mm (range, 2-6 mm) before surgery to 7 mm (range, 5-9 mm) after surgery, ulnar plus deformity improved by 5 mm. Radiographically the carbonated hydroxyapatite material was integrated completely into the bone tissue with evidence of progressive re-absorption and bony calcification over time. The Mayo wrist score system, according to Cooney and Krimmer modifications, improved by an average of 88 and 98 points (0-100 points), respectively. CONCLUSIONS: On the basis of this preliminary experience it is reasonable to consider carbonated hydroxyapatite as a viable alternative to bone grafting in conjunction with surgical correction of a distal radius malunion. It must be augmented, however, with internal fixation.     

Perilunate fracture-dislocations of the wrist: comparison of temporary screw versus K-wire fixation

PURPOSE: Temporary intercarpal screw fixation has been suggested as an alternative to temporary K-wire fixation in the treatment of perilunate wrist dislocations. We compared the 2 treatment methods in 2 retrospective cohorts with a null hypothesis that there would be no difference in final wrist motion. METHODS: Eighteen patients with surgically treated perilunate wrist dislocations (9 treated with intercarpal screws, 9 with intercarpal K-wires) were evaluated an average of 44 months after injury. The intercarpal screws were removed an average of 5 months and the K-wires an average of 3 months after the initial procedure. Complications included 3 pin track infections (1 with wrist sepsis), 2 scaphoid nonunions (screw fixation), and 2 patients with loss of reduction (K-wire fixation) treated with repeat surgery. RESULTS: Four patients (2 in each cohort) had wrist arthrodesis with poor results. Among the 14 remaining patients the final flexion arc was 97 degrees for patients treated with screw fixation compared with 73 degrees for patients treated with K-wires. The mean grip strength was 74% (screw fixation) and 67% (K-wire) that of the uninjured arm. According to the Mayo Modified Wrist Score, the functional result was excellent in 1 patient (screw), good in 2 patients (1 each group), fair in 6 patients (3 in each group), and poor in 9 patients (4 screws, 5 K-wire). Seven patients (2 screws, 5 K-wires) had grade 2 or 3 midcarpal arthritis according to the criteria of Knirk and Jupiter, but none had more than mild radiocarpal arthritis. CONCLUSIONS: The results of treatment with temporary screws are comparable to the results of treatment with temporary K-wires. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.     

High rate of complications associated with extrafocal kirschner wire pinning for distal radius fractures

Kirschner wire (K-wire) fixation is a common technique aimed at treating unstable distal radius fractures. We report our experience with extrafocal K-wire fixation in the treatment of unstable distal radius fractures in 34 patients (AO classification: 10 A2, 5 A3, 14 C1, and 5 C2). The patients' median age was 63 years (range, 16-87 years). K-wires remained in place for a median duration period of 42 days, and a splint was applied during 44 days in median. The median follow-up was 2.5 years (range, 1.3-5 years). At the final follow-up examination, all patients were assessed clinically and bilateral radiographs were taken. The median final range of motion was 69 degrees /64 degrees for extension/flexion, 88 degrees/82 degrees for pronation/supination and 36 degrees/21 degrees for ulnar/radial deviation. Grip strength was 81% of the contralateral side. Using the Gartland-Werley score, 12 patients (35%) had excellent results, 17 (50%) good, and five patients (15%) had fair results. The median final radiographic dorsal tilt was 4.5 degrees (range, 0-14 degrees) and 79% of patients had a loss of volar reduction (median 8 degrees). Radial inclination was in median 20 degrees (range, 10-32 degrees) with 82% of the patients with loss of reduction (median 5 degrees). Radial shortening was in median 0.9 mm (range, -2 to +5 mm) and 62% of patients had median loss of radial length of 1.1mm. Radial shortening was the major source of pain due to ulnar impingement. We found a high complication rate, with 15 patients (44%) suffering from at least one of the 30 reported complications. We did not find any direct correlation between radiographic results and mobility. Although good clinical outcome may be obtained, K-wire fixation cannot be routinely recommended.     

Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report

Using a volar approach to avoid the soft tissue problems associated with dorsal plating, we treated a consecutive series of 29 patients with 31 dorsally displaced, unstable distal radial fractures with a new fixed-angle internal fixation device. At a minimal follow-up time of 12 months the fractures had healed with highly satisfactory radiographic and functional results. The final volar tilt averaged 5 degrees; radial inclination, 21 degrees; radial shortening, 1 mm; and articular incongruity, 0 mm. Wrist motion at final follow-up examination averaged 59 degrees extension, 57 degrees flexion, 27 degrees ulnar deviation, 17 degrees radial deviation, 80 degrees pronation, and 78 degrees supination. Grip strength was 79% of the contralateral side. The overall outcome according to the Gartland and Werley scales showed 19 excellent and 12 good results. Our experience indicates that most dorsally displaced distal radius fractures can be anatomically reduced and fixed through a volar approach. The combination of stable internal fixation with the preservation of the dorsal soft tissues resulted in rapid fracture healing, reduced need for bone grafting, and low incidence of tendon problems in our study.     

外固定架结合组合克氏针治疗不稳定性桡骨远端关节内骨折

目的 探讨外固定架结合组合克氏针技术治疗不稳定性桡骨远端关节内骨折的方法及效果.方法 对46例不稳定桡骨远端关节内骨折患者,采用外固定架结合组合克氏针技术进行治疗.按AO/ ASIF分型:C1型27例,C2型16例,C3型3例.根据改良的Sarmiento评分,从掌倾角、尺偏角、桡骨短缩和关节面台阶方面对桡骨远端影像学进行评估;采用Gartland-Werley功能评分标准对腕关节功能进行评估,对结果进行统计学分析.结果 所有患者均获得10～ 42个月的随访,平均25个月.掌倾角由术前(- 18.5±10.2)°改善至术后(8.7±3.8)°,尺偏角由术前(- 14.6±4.5)°改善至术后(17.5±6.1)°,桡骨短缩由术前(6.0±2.1)mm改善至术后(0.7±0.3)mm,关节面塌陷由术前(5.3±3.6)mm改善至术后(0.8±0.2)mm.按Sarmiento评分标准评定:优31例,良15例;按GartlandWerley功能评分标准评定:优19例,良23例,可4例.结论 外固定架结合组合克氏针技术是治疗不稳定性桡骨远端关节内骨折的一种有效方法,复位固定可靠,手术创伤小,可减少复位丢失.     

Dynamic traction and minimal internal fixation for thumb and digital pilon fractures

PURPOSE: This study evaluates the use of limited internal fixation and dynamic traction for the treatment of severely displaced digital and thumb pilon fractures. METHODS: Six patients were evaluated both clinically and radiographically at an average of 29 months after surgery (range, 18-36 months) for pain, range of motion, and radiographic signs of joint space narrowing and congruence. Surgery involved the placement of a pin for dynamic traction and an assessment of the adequacy of the articular alignment. A limited incision and supplemental K-wires were often used to improve the position of severely displaced fragments or for the repair of the central tendon. RESULTS: Three patients were pain free, 2 patients experienced pain with prolonged activity, and 1 patient had pain associated with activities of daily living. Average digital arc of motion of the proximal interphalangeal joint was 94 degrees (range, 90 degrees-100 degrees) and thumb interphalangeal motion was 62.5 degrees (range, 60 degrees-65 degrees). The average duration of digital traction was 3.5 weeks. Four patients had greater than 1 mm incongruity of the articular surface immediately after surgery. At final evaluation, all patients had good joint congruency and 2 patients had joint space narrowing but were asymptomatic. There was 1 minor pin tract infection. CONCLUSIONS: Dynamic traction combined with limited internal fixation can be an effective treatment for displaced intra-articular pilon fractures. This technique may allow for earlier removal of traction and simultaneous repair of soft tissue injuries.     

Treatment of Distal Radius Fractures with Percutaneous Pinning and Pin-in-plaster

This article describes a modified technique that combines percutaneous pinning and casting. A prospective study was conducted on 54 patients with distal radius fracture who were treated with percutaneous Kirschner wire (K-wire) fixation and pin-in-plaster technique. The surgical indications of this technique included displaced extra-articular fracture, intra-articular fracture without significant comminution, and articular step-off less than 2 mm. The average radial height was 10.96 mm, and the volar tilt was 3.97 degrees on immediate postoperative radiographs. Upon removal of pin-in-plaster and percutaneous K-wires, the average radial height was 9.92 mm, and the volar tilt was 3.93 degrees . Bony union was achieved in all patients; the satisfaction rate was 90.7%. Pin-in-plaster technique is effective for maintaining reduction during bone healing. The procedure provides the ability to achieve anatomic reduction and then maintains this reduction through an adequate method of immobilization.     

The use of tricorticocancellous bone graft in severely comminuted intra-articular fractures of the distal radius

PURPOSE: We report the results of a retrospective study of the use of tricorticocancellous iliac crest bone graft in 12 patients with acute AO type C3.2 or type C3.3 fractures of the distal radius who were followed up for at least 1 year. METHODS: Twelve of 17 patients treated with the protocol were available for follow-up evaluation. All fractures were treated with open reduction and combined internal and external fixation. Five fractures were plated dorsally, 1 volarly, and 5 volarly and dorsally. RESULTS: Five patients had AO type C3.2 fractures and 7 had AO type C3.3 fractures. Nine of 10 radiographic parameters that were restored to near-normal values during the surgery were maintained at near-normal levels at the final follow-up evaluation at a mean of 28 months after surgery. Nine fractures had less than 2 mm of articular step-off of the distal radius and 8 had less than 3 mm of total articular incongruity (gap plus step-off). In 10 patients the radial length was restored to at least 10 mm. The mean arc of flexion-extension was 67% and the mean grip strength was 57% of that of the uninjured side. According to the Gartland and Werley demerit-point system 5 of the patients had good or excellent results. According to the modified Green and O'Brien clinical rating system 2 patients had good or excellent results. Poor results for 2 patients according to the demerit-point system and for 6 patients according to the Green and O'Brien clinical rating system were associated with severe ipsilateral soft-tissue and osseous injuries of the wrist, forearm, and arm. The total articular incongruity had a moderately strong correlation with the outcome as assessed by the demerit-point system. CONCLUSIONS: Tricorticocancellous bone grafting in conjunction with combined internal and external fixation is a satisfactory treatment that can lead to a high rate of return to work and sports, a high level of patient satisfaction, and a low rate of complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Results of palmar plating of the lunate facet combined with external fixation for the treatment of high-energy compression fractures of the distal radius

OBJECTIVES: The study evaluated the outcome of the treatment of patients who sustained high-energy, compression-type injuries of the distal radius. DESIGN: The retrospective study evaluated the outcome of reduction and plating of the lunate facet in conjunction with standard external fixation. SETTING: A Level I trauma center. PATIENTS: Inclusion criteria for study participation included: 1) age between 18 and 65 years of age with no evidence of concomitant metabolic bone disease; and 2) a 3- or 4-part compression type fracture of the distal radius with residual displacement of the palmar lunate facet despite reduction of the dorsal cortex by the application of an external fixator. INTERVENTION: Fractures were treated with palmar plating of the depressed lunate facet combined with dorsal external fixation. MAIN OUTCOME MEASUREMENTS: Posttreatment evaluations consisted of measurements of range of motion, grip strength, radiographic evaluations, and completion of Disability of Arm, Shoulder, and Hand questionnaires. RESULTS: Three months after surgery, 20 of 21 patients exhibited full range of motion at the MCP/PIP joints. At the 2-year follow-up, an average palmar tilt of +1.0 degrees, radial inclination of 24 degrees, radial length of 12 mm, ulnar variance of 0.5 mm, intra-articular gap of 0.1 mm, and intra-articular step-off of 0.3 mm was documented. Using the Garland and Werley rating system, results were rated as excellent or good for 18 wrists, fair for 2 wrists, and poor for 1 wrist. Mean Disability of Arm, Shoulder, and Hand functional scores and athletic scores improved at 6 months. CONCLUSIONS: Reduction and plating of the lunate facet in conjunction with standard external fixation permits: 1) visualization and reduction of the palmar lunate facet; and 2) reduction of palmar tilt to neutral tilt without significant radial shortening. This technique should be considered as an acceptable option in the treatment of high-energy fractures of the distal radius.     

Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation

PURPOSE: The purpose of this study was to compare the outcomes of 2 treatments for unstable distal radius fractures: open reduction internal fixation (ORIF) through a volar approach with a fixed-angle implant and a standard external fixation (EF) method. METHODS: This study included patients with comminuted unstable intra-articular and extra-articular distal radius fractures treated by a single surgeon. Data were gathered retrospectively on 11 patients treated with EF who had been followed up for an average of 47 months (range, 12-84 mo). Prospective data were gathered on 21 patients who were treated with ORIF through a volar approach with a fixed-angle implant. Follow-up evaluation for this group averaged 17 months (range, 12-24 mo). The 2 groups were compared for range of motion (ROM), strength, and functional outcome as measured by the Patient Rated Wrist Evaluation (PRWE) and the Disability of the Arm, Shoulder, and Hand Questionnaire (DASH). Fracture reduction was evaluated from radiographs taken at the last follow-up visit and compared between groups. RESULTS: The mean passive wrist ROM at the final follow-up evaluation in EF patients was 59 degrees extension and 57 degrees flexion, compared with 63 degrees extension and 64 degrees flexion in patients treated with ORIF. Passive pronation/supination arc of motion was similar for the 2 groups, as were the DASH and PRWE scores. Grip strength as a percentage of the opposite wrist was significantly greater in the external fixation group, a possible consequence of longer follow-up evaluation. Final radiographic measurements for the EF group averaged 5 degrees volar tilt and 25 degrees radial inclination, with 2.2-mm ulnar-positive variance. The ORIF with volar plating group averaged 10 degrees volar tilt and 22 degrees radial inclination, with .5-mm ulnar-negative variance. Radial length and volar tilt were significantly greater for the ORIF group. The average final intra-articular step-off was significantly different, with 1.4-mm step-off in the EF group and .4 mm in the ORIF group. CONCLUSIONS: The use of ORIF with a volar fixed-angle implant resulted in stable fixation of the distal articular fragments, allowing early postsurgical wrist motion. The PRWE and DASH scores for the groups were equivalent, whereas intra-articular step-off, volar tilt, and radial length were better in the ORIF group. There were few complications, implant removal was not necessary, and early postsurgical wrist ROM was initiated without loss of reduction.     

Antegrade intramedullary K-wire fixation for distal radial fractures

Manual reduction and antegrade intramedullary K-wire fixation were performed for 29 selected Colles-type distal radial fractures in 29 patients. Severely comminuted intra-articular fractures and Barton's fracture were not included in this study. The tips of the K-wires supported an articular surface of the distal radius. Except for 1 case of skin irritation in the forearm, there were no complications related to tendon or nerve injuries or reflex dystrophy. There was no pin loosening, but protrusion of sharp tips of K-wires into the wrist joint occurred in 3 patients. Average volar tilt, radial shortening, and step-off at follow-up evaluation were 5 degrees, 2.6 mm, and 0.2 mm, respectively. These radiologic results were consistent with values reported in other pinning studies; however, radial shortening was not controlled effectively. Fourteen (48%) of 29 patients had radial shortening >3 mm. The advantages of this surgical procedure are the low occurrence rate of soft-tissue complications and prevention of dorsal angulation of fractures.     

Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient

PURPOSE: Increased incidence of falls and osteoporosis combine to make distal radius fractures a major cause of morbidity for the elderly patient. This report presents our experience treating distal radius fractures in the elderly population using a volar fixed-angle internal fixation plate. METHODS: We reviewed retrospectively all patients older than 75 years treated during a period of 4 years and 7 months at our centers for unstable distal radius fractures using a volar fixed-angle plate. Postoperative management included immediate finger motion, early functional use of the hand, and a wrist splint used for an average of 3 weeks. Standard radiographic fracture parameters were measured and final functional results where assessed by measuring finger motion, wrist motion, and grip strength. RESULTS: Of 26 patients that fit the inclusion criteria, we were able to evaluate 23 patients with 24 unstable distal radius fractures for an average of 63 weeks. Final volar tilt averaged 6 degrees and radial tilt 20 degrees, and radial shortening averaged less than 1 mm. The average final dorsiflexion was 58 degrees, volar flexion 55 degrees, pronation 80 degrees, and supination 76 degrees. Grip strength was 77% of the contralateral side. There were no plate failures or significant loss of reduction, although there was settling of the distal fragment in 3 patients (1-3 mm). CONCLUSIONS: The treatment of unstable distal radius fractures in the elderly patient with a volar fixed-angle plate provided stable internal fixation and allowed early function. This technique minimized morbidity in the elderly population by successfully handling osteopenic bone, allowed early return to function, provided good final results, and was associated with a low complication rate.     

关节镜辅助治疗桡骨远端关节内骨折

目的 报告关节镜在桡骨远端关节内骨折复位固定中的辅助作用.方法 回顾2004-2007年间我院收治的12例桡骨远端骨折,在开放复位内固定术中应用关节镜进行腕关节内观察,检测关节面的对位情况,术后以放射学检查评估关节面的对位,并测量桡骨高度、掌倾角及桡偏角,随访临床腕关节功能恢复情况.结果 随访时间平均为24个月,12例桡骨远端关节内骨折术后均未出现关节面阶梯改变.X线片检查:桡骨高度平均为12 mm(7～15 mm),掌倾角平均为5°(1°～9°),桡偏角平均为20°(14°～28°).腕关节活动度:屈曲平均为33°(18°～42°),背伸平均为38°(21°～42°).6例活动时有轻微疼痛.根据Gartland和Werley的评估标准评定:优5例,良7例.结论 应用腕关节镜辅助治疗桡骨远端关节面骨折复位可避免关节面出现阶梯改变,最大程度地恢复关节的功能.     

Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation

BACKGROUND: Severely comminuted AO type-C3 intra-articular fractures of the distal end of the radius are difficult to treat. Failure to achieve and maintain nearly anatomic restoration can result in pain, instability, and poor function. We report the results of a retrospective study of the use of a standard protocol of open reduction and combined internal and external fixation of these fractures. METHODS: Seventeen of twenty-five patients treated with the protocol were available for follow-up evaluation. Six had an AO type-C3.1 fracture; eight, type-C3.2; and three, type-C3.3. Eleven fractures required a dorsal buttress plate and/or a volar buttress plate, and eleven required bone-grafting. The mean time until the external fixator was removed was seven weeks. RESULTS: At a mean of thirty months postoperatively, the mean arc of flexion-extension was 72% of that on the uninjured side and the mean grip strength was 73% of that on the uninjured side. The mean articular step-off was 1 mm, the total articular incongruity (the gap plus the step-off) averaged 2 mm, and the radial length was restored to a mean of 11 mm. Thirteen patients had less than 3 mm of total articular incongruity. Arthritis was graded as none in three patients, mild in ten, moderate in three, and severe in one. According to the Gartland and Werley demerit-point system, ten of the patients had a good or excellent result. According to the modified Green and O'Brien clinical rating system, five had a good or excellent result. One patient had a fracture collapse requiring wrist fusion, one had reflex sympathetic dystrophy, and three had minor Kirschner-wire-related problems. Total articular incongruity immediately postoperatively had a moderately strong correlation with the outcome as assessed with both clinical rating systems (r = 0.70 and 0.74 for the Gartland and Werley system and the Green and O'Brien system, respectively; p<0.05). CONCLUSIONS: Open reduction and combined internal and external fixation of AO type-C3 fractures can restore radiographic parameters to nearly normal values, maintain reduction throughout the period of fracture-healing, and provide satisfactory functional results.     

Dorsal plating for comminuted intra-articular fractures of the distal end of the radius.

Forty-one dorsally displaced intra-articular fractures of the distal radius were treated by open reduction and internal fixation with the dorsal Symmetry plates. The average age at the time of the injury was 49 years. An average follow-up period was 15 months. The final radial length averaged 11 mm, radial inclination 23 degrees, volar tilt 7 degrees, ulnar variance 1.5 mm, and articular incongruity 0.3 mm. According to the Gartland and Werly scales, 36 fractures were excellent and five were good. However, ulnar variance increased more than 3 mm during follow-up in eight patients, and volar tilt increased more than 5 degrees during follow-up in ten patients. Use of dorsal Symmetry plate is effective for unstable comminuted intra-articular distal radius fractures, but severely comminuted fractures may possibly undergo re-displacement post-operatively.     

Treatment of the unstable distal radius fracture with external fixation and a hydroxyapatite spacer

A prospective study was performed on 25 patients (15 women, 10 men) with unstable fractures of the distal radius selectively treated with a dynamic type of external fixation combined with a hydroxyapatite spacer. The fractures ranged from type VI to type VIII according to Frykman's classification. The patients' mean age at surgery was 49 years (range, 19-75 years). The mean follow-up period was 2.5 years, and overall outcome was assessed using Gartland and Werley's demerit point system as modified by Sarmiento. Radial inclination was 26 degrees +/- 4 degrees at the time of reduction and 26 degrees +/- 5 degrees at follow-up, palmar tilt was 9 degrees +/- 2 degrees at reduction and 8 degrees +/- 3 degrees at follow-up, and ulnar variance was 1.4 +/- 0.6 mm at reduction and 2.1 +/- 0.9 mm at follow-up. The mean range of motion at follow-up was 80 degrees +/- 10 degrees in flexion, 80 degrees +/- 10 degrees in extension, 85 degrees +/- 10 degrees in supination, and 80 degrees +/- 5 degrees in pronation. The outcome in 24 of 25 patients was evaluated as excellent. In the surgical treatment of unstable fractures of the distal radius using external fixator, the fracture reduction should be supported with bone graft or a bone substitute, and a hydroxyapatite spacer was considered to be a useful substitute for a bone graft.     

腕关节镜辅助可动力化外固定器技术治疗桡骨远端关节内骨折

目的采用腕关节镜辅助可动力化外固定器技术治疗桡骨远端关节内骨折,并初步评价其治疗效果。方法15例桡骨远端关节内骨折患者,采用腕关节镜辅助可动力化外固定器技术治疗。常规X线片检查结合腕关节镜观察,测量手术前后尺偏角、掌倾角、桡骨短缩、关节面“台阶”和关节内骨折缝隙。患者主观症状用疼痛标尺法测量,腕关节功能按Sarmiento改良的Gartland-Werley计分法评价。结果术后患肢掌倾角、尺偏角、桡骨短缩和关节内骨折复位情况除2例关节内骨折缝隙大于2mm外,均获得满意效果;患者疼痛计分平均1.2分;腕关节功能优10例,良4例,一般1例。结论通过本组病例观察,可动力化外固定器技术可以较好地维持桡骨远端关节内骨折的稳定。腕关节镜手术有助于精确恢复关节面的平整。两项技术的结合使用较好地解决了维持桡骨关节面高度和恢复关节面平整的问题。