Open reduction and internal fixation of displaced intraarticular fractures of the distal radius: 31 patients followed for 3-7 years

We have used open reduction and internal fixation with a T-plate in 31 displaced, intraarticular fractures of the distal radius which were judged irreducaible or in which closed reduction failed. The mean follow-up time was 4 (3-7) years. The dorsal angulation, the radial length, the articular step-off and the intraarticular gap between fragments were substantially improved after surgery. 30 patients had excellent or good extraarticular alignment, and only 1 patient had a postoperative intraarticular step-off of 2 mm. The function was excellent or good in 26 patients at follow-up. Complications occurred in 6 patients: 1 compartment syndrome, 1 postoperative wound infection, 2 ruptures of the extensor pollicis longus tendon, and 2 patients had median nerve paresthesias.     

Long-term outcome of nonsurgically treated distal radius fractures

PURPOSE: To study the long-term outcome after nonsurgically treated distal radius fractures including recovery of grip strength, mobility, and radiographic parameters. METHODS: Eighty-seven patients, mean age 55 (range 19-78) years, treated with closed reduction and casts, were evaluated radiographically and clinically during the first 6 months and finally after 9-13 years. Fifty patients had extra-articular fractures (AO Class A), 4 had simple intra-articular fractures (AO Class B) and 33 had complete intra-articular fractures (AO Class C). RESULTS: Fifty-two of 66 patients with unilateral fractures were, after 9-13 years, rated as excellent/good according to the Green and O'Brien score as modified by Cooney et al (GOBC score). Fracture class according to AO did not correlate to outcome. Considerable fracture displacements remained: dorsal angulation (mean 13 degrees in <60 y, 18 degrees in >/=60 y), greater radial shortening than initially (mean 2 mm in <60 y, 3 mm in >/=60 y). Five patients had remaining joint step-off (1-2 mm) after reduction, but only one developed mild osteoarthritis. Patients with an unsatisfactory outcome had sustained more displaced fractures that also healed with greater displacement. The remaining subjective complaints were pain or reduced function during heavier tasks. Outcome was not correlated to age. Wrist mobility returned notably faster than grip strength. Patients over 60 years of age recovered slower in both mobility and strength. Closed reduction and plaster improved dorsal angulation but not radial shortening. CONCLUSIONS: Our data indicate that a number of patients with nonsurgically treated distal radius fractures still experience some hand/wrist impairment a decade after the trauma. The severity of fracture displacement seems to influence the clinical outcome in contrast to patients' age. Recovery of grip strength is slower than that of range of motion. Elderly patients recover more slowly than young patients. Dorsal angulation was improved but remained considerable (13 degrees -18 degrees ), while final radial shortening (2-3 mm) increased from the injury status.     

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.     

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.     

Winkelstabile, volare Plattenosteosynthese komplexer artikulärer Frakturen am distalen Radius

Fractures of the distal radius represent one of the most common fractures and have high socioeconomic relevance. Using the volar approach to avoid the soft tissue problems associated with dorsal plating, we treated a consecutive series of 49 displaced intra-articular distal radius fractures with a new fixed-angle internal fixation device. According to the AO classification, there were 21 C1, 19 C2, and nine C3 fractures. A retrospective study was carried out to obtain the functional results after open reduction and plate osteosynthesis. Loss of correction between postoperative and follow-up radiography was 1 degrees in volar tilt and radial inclination. The radial shortening was 1 mm. Wrist motion at final follow-up examination had recovered to an average of 80% of that at the normal, contralateral site. Overall outcome according to the Gartland and Werley scales showed 35% excellent, 50% good, and 15% fair results. Using the Martini score, we obtained 85% excellent and good results. The DASH score represented high subjective satisfaction.     

Long-term results of dorsally displaced distal radius fractures treated with the pi-plate: is hardware removal necessary?

The purpose of this study was to evaluate the outcome of patients treated with open reduction and internal fixation (ORIF) using dorsal plates and screws (AO/ASIF pi-plate) for dorsally displaced fractures of the distal radius. Although extensor tendon rupture is a recognized complication of all distal radial fractures, there appears to be an increased risk of this using dorsal plating. In addition, there is the added complication of extensor tendon irritation and dorsal wrist pain, which may necessitate plate removal. The low-profile pi-plates intended to overcome this problem have not done so, with quoted rates ranged from 19% to 55%.We treated 32 completely evaluated patients (13 men and 19 women) in our department between 2000 and 2004, with an average age of 46 years. They underwent ORIF of dorsally displaced fractures of the distal radius using the specially designed pi-plate. Bone graft was used in 18 patients who had significant metaphyseal defect. Clinical examination, plain radiographs, and functional assessments using the modified Mayo Wrist Score were performed at an average follow-up of 86 months (range, 56-115 months). Satisfactory reduction was achieved in all 32 fractures at the time of operative fixation with no instances of loss of fracture reduction during the study period. According to the Mayo Wrist Score, 23 patients (72%) had excellent or very good results, 7 (22%) had fair results, and 2 (6%) had poor results. Two cases (6.25%) of extensor tendon rupture were noted during the first postoperative month, and 2 other patients showed progressive weakness of index finger extension 6 months postoperatively. The remaining 28 patients had no soft tissue problems.     

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.     

Operative treatment and outcome of unstable distal radial fractures using a palmar T-miniplate at a non-specialized institution

Treatment options for displaced distal radial fractures are still a controversial topic of discussion. Although good results for the palmar plating of high-volume centers have been published, evidence of its successful use in smaller institutions is still lacking. We report the clinical and radiological results of the treatment for 84 distal radial fractures with a single 2.4-mm T-miniplate in an institution performing <30 procedures per year. According to the AO classification system, there were 30 A, 5 B, and 49 C fractures with a patients mean age of 64 years. After a minimum of 12-month follow-up, we found very good and good results according to the Gardland and Sarmiento scores and a DASH of 5.6. Only five patients were classified as having a moderate outcome. A remaining intra-articular step-off of more than 1 mm was seen in 15 patients. In a comparison of grip strength between the injured and uninjured hands, we saw a difference of 6.8 % less on the injured side. We saw two instances of tendon rupture and one of tendon irritation due to prominent dorsal screws and necessitating revision surgery. Flexor tendon irritation was noted in one patient, requiring a second operation. Modern treatment for distal radial fractures can be performed successfully and with good clinical outcome in smaller institutions. Based on the high and increasing incidence of distal radial fractures, there is no need to transfer these patients into high-volume centers. Level of evidence Case study, Level IV.     

Pin reduction and fixation of volar fracture fragments of distal radius fractures via the flexor carpi radialis tendon

BACKGROUND: The objective of this study was to evaluate a technique for reduction and stabilization of residually displaced volar fragments in intraarticular distal radius fractures. METHODS: A consecutive series of patients with AO type C3 distal radius fractures treated by one surgeon were studied. Percutaneously placed pins were placed through the flexor carpi radialis tendon to reduce and stabilize volar fracture fragments of distal radius fractures when closed reduction was unsuccessful. The goal of treatment was to achieve less than 2 mm of articular congruity. Postoperative physiotherapy was protocol-based. A validated outcome measurement was used to evaluate patients. RESULTS: Of 117 patients, 10 met the inclusion criteria. In all patients, a successful reduction of the volar fragment was achieved with less than 2 mm of residual articular step-off. Reduction was maintained in 8 patients. Follow-up averaged 29 months, and there were no complications associated with the technique. All patients were satisfied with the treatment. CONCLUSION: Although the final outcome of patients with this type of fracture depends on many factors, in the small series of patients described, a satisfactory reduction was possible using the describe technique. Transtendinous pinning is a new, undescribed technique that is useful in the treatment of such specific injuries.     

Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates

PURPOSE: To determine whether volar fixed-angle plate fixation with a new plate system could be used to treat dorsally unstable distal radius fractures. We hypothesized that volar fixed-angle plate fixation with or without radial styloid fixed-angle plate fixation would provide sufficient rigidity to allow early active range of motion without compromising fracture reduction. The initiation of early active motion may improve functional outcomes. METHODS: A retrospective review was conducted of one institution's initial experience using a new volar fixed-angle plate system to treat dorsally displaced intra-articular and extra-articular distal radius fractures. Thirty-two fractures in 32 patients with dorsally displaced distal radius fractures were treated with a volar fixed-angle plate with or without a radial styloid fixed-angle plate. Fractures were classified using the AO classification. Radiographic parameters on preoperative, postoperative, and final follow-up radiographs were compared. The time to initiation of active range of motion was determined. Final follow-up ranges of motion and complications were reported. Finally, comparisons were made between the 23 fractures treated with a volar plate alone and the 9 fractures treated with a volar plate and a radial styloid plate. RESULTS: The average follow-up period was 13 months. Two thirds of the fractures were intra-articular. Average loss of reduction from initial postoperative to final follow-up radiographs was 0 degrees of volar tilt, 1 degrees of radial inclination, and 0 mm of radial length. Active wrist and forearm ranges of motion were initiated at an average of 11 days after surgery. The final follow-up flexion-extension and pronation-supination arcs averaged 112 degrees and 151 degrees , respectively. The 9 fractures treated with the combination of a fixed-angle volar plate with a fixed-angle radial styloid plate had greater initial displacement than did the 23 fractures treated with a volar plate alone. Otherwise, differences between the 2 groups were not significant. Only 1 radial styloid plate became symptomatic. CONCLUSIONS: Volar plate fixation using a new fixed-angle plate system successfully can stabilize dorsally unstable distal radius fractures. Early active range of motion was facilitated without compromising fracture reduction.     

Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius

The results in sixteen patients who had a displaced, comminuted intra-articular fracture of the distal end of the radius and who were treated by open reduction and internal fixation were retrospectively reviewed. At a mean follow-up of 4.8 years, 81 per cent of the patients had a rating of good or excellent by the scoring system of Gartland and Werley, but only 56 per cent had such a rating when the modified scoring system of Green and O'Brien was used. All of the fractures healed at an average of nine weeks. A step-off of two millimeters or more in the distal radial articular surface at the time of healing was important, because the four patients in whom the fracture healed with this amount of incongruity all had post-traumatic arthritis at follow-up, compared with only three of twelve in whom the incongruity was less than two millimeters.     

关节镜诊治关节内桡骨远端粉碎性骨折的软组织损伤

Objective To diagnose and evaluate soft tissue injuries in intra-articular fractures of the distal radius using arthroseopy. Methods Twenty young patients with displaced intra-articular fractures of distal radius were recruited in this prospective study. Three AO C2 and 17 C3 fractures were included. After arthroseopie examination fractures of distal radius were treated by external fixation with limited internal fixation or open plate fixation. Results Triangular fibrocartilage complex （TFCC） injury was found in 18 patients （90%） . Most were isolated Palmer type 1D injuries （67 % ）. Seapho-lunate ligament injury was found in two patients： one partial tear （grade H） and one complete tear （grade HI ）. Follow-ups ranged from 6 to 18 months. At the last follow-up, wrist function was excellent in one patient （6%）, good in eight（44% ） and fair in 11 （50%）. Conclusion TFCC injuries are common in intra-artieular fractures of the distal radius while injuries to seapho-lunate ligament are uncommon.     

Intra-articular distal radius fractures: Arthroscopic assessment of radiographically assisted reduction

The optimal means of assessing articular displacement during closed reduction of distal radius fractures is unknown. The purpose of this study was to evaluate the in vivo accuracy of fluoroscopy (C-arm) and plain radiographs (XR) in measuring articular step-off and gap and to determine if postreduction arthroscopy can identify malreduced intra-articular fractures that would benefit from reduction. Fifteen intra-articular distal radius fractures underwent closed manipulation and percutaneous pinning. Reduction was assessed sequentially by C-arm, XR, and wrist arthroscopy. The width of gapping between articular surface fragments was underestimated to a statistically significant degree by both C-arm and XR. The magnitude of articular step-off measured with arthroscopy was not statistically different than that measured radiographically. In 5 (33%) cases, the optimal reduction obtained using C-arm and XR was found to have an articular displacement of >1mm by adjunctive arthroscopy. Complete reduction and pinning was performed with satisfactory results. These results suggest that adjunctive arthroscopy may detect residual gapping of the articular surface that is not seen by C-arm or XR. Residual displacement noted by adjunctive arthroscopy may prompt another reduction effort and result in an improved articular alignment of intra-articular distal radius fractures.     

Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures

The aim of this study is to compare the radiological and functional outcomes of open reduction and volar locking plates versus external fixation (EF) in the treatment of unstable intra-articular distal radius fractures. In this retrospective comparative study, 69 of 80 patients who underwent an operation for AO/ASIF C1, C2 and C3 distal radius fractures were assessed. Functional evaluation was performed using the Gartland–Werley scoring system and the PRWE scale, and wrist range of motion and grip strength was also measured. For the radiological assessment, radial inclination, volar tilt, radial length, ulnar variance, and articular step-off were compared. The range of movement was better for all parameters in the volar plate group, but only wrist flexion and pronation range differed significantly between the groups (p = 0.037 and p = 0.014, respectively). With the exception of better subjective functional results in the volar plate group, the differences were not significant. With respect to radiological evaluation, all parameters were better in the volar plate group, but only radial inclination and articular step-off were significantly better (p = 0.018 and p = 0.029, respectively). In the volar plate group, two patients had carpal tunnel syndrome and one patient had regional pain syndrome. In the external fixator group, six patients had superficial pin tract infection, two patients had sensory branch injury, and four patients had regional pain syndrome. Volar locking plate fixation appeared as a dependable method for the treatment of intra-articular distal radius, with lower complication rates. On the other hand, EF remains a suitable surgical alternative for these fractures, with easy application and acceptable results.     

Transient retrograde interfragmentary compression technique in AO/OTA type 33-C distal femur fractures: A surgical technique and short-term radiographic follow up results

Surgical treatment of AO/OTA type 33-C fractures is a therapeutic challenge despite advances in surgical instruments and techniques. We introduce a novel surgical technique named transient retrograde interfragmentary compression (TRIC) to help intraarticular fragment reduction in AO/OTA type 33-C fracture. We inserted a partial threaded 7.0-cannulated screw with a washer along the transepicondylar axis from the medial femoral epicondyle during the articular block reduction process of AO/OTA type 33-C fractures to strengthen the compressive force between the condylar fragments and to enhance the handling of the articular block fragment in the alignmental correction stage. Following the provisional reduction and fixation using lateral distal femur locking compression plate, TRIC screw was removed. Fifteen AO/OTA type 33-C distal femoral intraarticular fractures of thirteen patients were surgically treated using the TRIC technique. We analyzed the radiographic result of the patients by measuring the horizontal gap and vertical step-off in the postoperative radiographs. Mean horizontal fracture gap was 0.34 mm and mean vertical step-off between bicondylar fragments was 0.63 mm. The median value of the horizontal fracture gap and vertical step off was 0 and 0.46 mm, respectively. Mean time to union in the bicondylar fracture fragment was 9 week. TRIC is considered to be a valuable surgical reduction technique in the treatment of the AO/OTA 33-C type fractures.     

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.     

Dorsal (AO/ASIF) pi-plate osteosynthesis in the treatment of distal intraarticular radius fractures

The results and complications using the dorsal 2.4 mm 2.7 mm (AO/ASIF) pi-plate for the treatment of distal radius fractures were evaluated in a prospective study of 42 patients followed up clinically and radiologically and seven patients followed up with telephone call and radiological follow-up for an average time of 12.1 (range 4-32) months in a group of 50 patients with intraarticular distal radial fractures treated consecutively using this method. Twelve complications occurred in 10 patients including two extensor tendon ruptures, two transient cases of CRPS Type 1 (Reflex Sympathetic Dystrophy, Algodystrophy), two instances of screw loosening, three cases of posttraumatic carpal tunnel syndrome and three permanent sensory irritations on the dorsum of the hands. Using the AO score, there were 37 successful and 12 tolerable results, with no unsatisfactory outcomes. Using the NYOWR scale, there were 17 very good and 25 good results, with no satisfactory or poor outcomes. These results suggest that this osteosynthesis provides adequate fixation of comminuted distal intraarticular radius fractures with a reasonable incidence of complications.     

Arthritis predicting factors in distal intraarticular radius fractures

Introduction

Intra-articular malunion with step off and gap formation is claimed to be crucial for radiocarpal degeneration. In addition to well-defined intraarticular malunion, the shape of the distal radius is important for unaffected wrist function. In typical intra-articular fracture patterns with a dorsoulnar and palmar ulnar fragment, alterations of the shape of the articular surface, in a kind of a cavity, without obvious step off can be observed. The aim of the present study is to determine the residual articular deformity following intra-articular radius fractures and to analyze their impact on the final clinical and radiological outcome.

Materials and methods

Eighty one patients with dorsally displaced distal intraarticular radius fractures were followed up for a mean period of 9 years. Surgical treatment of all patients included open reduction, plate fixation and corticocancellous bone grafting. Radiological measurements included palmar tilt, radial inclination and radial shortening as defined by ulnar variance, intra-articular Stepps and the measurement of the anteroposterior distance of the radial joint surface. Clinical assessment included active range of motion (ARM) of the wrist, pain according to a visual analogue scale (VAS), grip power, working ability, Disability of Arm, Shoulder and Hand Score (DASH Score).

Results

Articular malunion in the form of a cavity in the sagittal plane measured 4.8?mm, 1.3?mm more than on the non-injured side. Anteroposterior distance measured 20.6?mm, 2.1?mm more than on the non-injured side. Articular step-off and gap was noticed in 11 patients. At the final follow-up examination, there was a significant difference in articular cavity depth and the anteroposterior distance between arthritis stage I and II. Arthritis stage was associated with the range of motion (ROM) in the sagittal plane, but had no significant influence on the DASH, pain level, grip strength and ROM in the frontal plane.

Conclusion

ORIF leads to predictable results in the restoration of length and form of the distal radius. Increasing the articular cavity depth should be avoided to prevent degenerative arthritis at the radiocarpal joint at long-term follow-up visits.     

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.     

Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study

PURPOSE: Controversy exists surrounding the effectiveness and complications associated with dorsal plating for distal radius fractures. This study evaluated the functional outcome of dorsal plating for dorsally angulated distal radius fractures at a single institution. METHODS: Thirty patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared with the uninjured side were recorded. The functional outcome was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Gartland and Werley scoring system. RESULTS: The median patient age at surgery was 59 years. The median follow-up period was 18 months. According to the AO classification system, there were 4 type A fractures, 5 type B fractures, and 21 type C fractures. The median preoperative dorsal angulation was 30 degrees, and the median postoperative angulation was -4 degrees volar. Sixteen patients with fractures had an intra-articular step-off or gap, which were all corrected to neutral by the procedure. Seven patients with the fractures showed positive ulnar variance, all corrected to neutral at time of follow-up evaluation. Compared with the contralateral side, the mean extension and flexion were 88% and 81%, respectively; pronation and supination were 89% and 87%, respectively; and grip strength and thumb pinch were 78% and 94%, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 points, and 28 patients had Gartland and Werley scores of good or excellent. No patients needed to have their plates removed, and no extensor tendon rupture was reported. One patient lost reduction, 1 patient needed a tenolysis of the extensor pollicis longus tendon, and 2 patients required the removal of a single metaphyseal screw. CONCLUSIONS: Results from this study show that patients can expect to have 80% of their range of motion and strength after dorsal plating for distal radius fractures. Moreover, 93% of the patients will have good to excellent functional outcomes. Complications from dorsal plating may be caused by the specific plate used, rather than by the technique itself, supporting a dorsal approach for dorsally angulated distal radius fractures.