Title: Treatment of Intra Articular Fractures of Distal Radius Using External Fixator: A Short Term Study
Authors: Mehmood Ul Hassan Mufti, Sheikh Ajaz, Muhammad Ashraf Khan, Raja Rameez Farooqi, Hilal Ahmad Kotwal
DOI: http://dx.doi.org/10.18535/jmscr/v4i9.71
Abstract
Background: Severely comminuted 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 closed reduction and external fixation of these fractures.
Methods: Fifty patients underwent closed reduction and external fixation with or without augmentation with k-wires. Thirty-three patients required additional k-wires. The mean time until the external fixator was removed was seven weeks.
Study Design & Settings: Observational prospective study at a tertiary care hospital from September 2013 to August 2015.
Results: At a mean of thirteen months postoperatively, the mean arc of flexion-extension was 82% of that on the uninjured side and the mean grip strength was 83% of that on the uninjured side. The mean articular step-off was 1 mm and the radial length was restored to a mean of 11 mm. According to the modified Green and O’Brien clinical rating system, twenty-five had a good or excellent result. Thirteen patients had minor Kirschner-wire-related problems.
Conclusions: Closed reduction and external fixation of intra-articular fractures can restore radiographic parameters to nearly normal values, maintain reduction throughout the period of fracture-healing, and provide satisfactory functional results.
References
1. Colles A. On the Fracture of the Carpal Extremity of the Radius. Edinb Med Surg J. 1814; 10: 182-6.
2. Axelrod TS, McMurtry RY. Open reduction and internal fixation of commin-uted, intraarticular fractures of the distal radius. J Hand Surg [Am]. 1990;15:1-11.
3. Bass RL, Blair WF, Hubbard PP. Results of combined internal and external fixation for the treatment of severe AO-C3 fractures of the distal radius. J Hand Surg [Am]. 1995;20:373-81.
4. Jupiter JB. Current concepts review. Fractures of the distal end of the radius. J Bone Joint Surg Am. 1991;73:461-9.
5. Jupiter JB, Lipton H. The operative treatment of intraarticular fractures of the distal radius. ClinOrthop. 1993;292:48-61.
6. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647-59.
7. Missakian ML, Cooney WP, Amadio PC, Glidewell HL. Open reduction and internal fixation for distal radius fractures. J Hand Surg [Am]. 1992;17:745-55.
8. Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg [Am]. 1994;19:325-40.
9. Bartosh RA, Saldana MJ. Intraarticular fractures of the distal radius: a cadaveric study to determine if ligamentotaxis restores radiopalmar tilt. J Hand Surg [Am]. 1990;15:18-21.
10. Cooney WP 3rd, Dobyns JH, Linscheid RL. Complications of Colles’ fractures. J Bone Joint Surg Am. 1980;62:613-9.
11. Edwards GS Jr. Intra-articular fractures of the distal part of the radius treated with the small AO external fixator. J Bone Joint Surg Am. 1991;73:1241-50.
12. Leung KS, Shen WY, Tsang HK, Chiu KH, Leung PC, Hung LK. An effective treatment of comminuted fractures of the distal radius. J Hand Surg [Am]. 1990;15:11-7.
13. Melone CP Jr. Open treatment for displaced articular fractures of the distal radius. ClinOrthop. 1986;202:103-11.
14. Taleisnik J, Watson HK. Midcarpal insta-bility caused by malunited fractures of the distal radius. J Hand Surg [Am]. 1984; 9:350-7.
15. Weber SC, Szabo RM. Severely commin-uted distal radial fracture as an unsolved problem: complications associated with external fixation and pins and plaster techniques. J Hand Surg [Am]. 1986; 11:157-65.
16. Yen ST, Hwang CY, Hwang MH. A semiinvasive method for articular Colles’ fractures. ClinOrthop. 1991;263:154-64
17. Nakata RY, Chand Y, Matiko JD, Frykman GK, Wood VE. External fixators for wrist fractures: a biomechanical and clinical study. J Hand Surg [Am]. 1985;10:845-51.
18. Jenkins NH, Jones DG, Johnson SR, Mintowt-Czyz WJ. External fixation of Colles’ fractures. An anatomical study. J Bone Joint Surg Br. 1987;69:207-11.
19. Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am. 1989;71:839-47
20. Cooney WP 3rd, Linscheid RL, Dobyns JH. External pin fixation for unstable Colles’ fractures. J Bone Joint Surg Am. 1979;61:840-5.
21. Fernandez DL, Geissler WB. Treatment of displaced articular fractures of the radius. J Hand Surg [Am]. 1991;16:375-84.
22. Szabo RM, Weber SC. Comminuted intraarticular fractures of the distal radius. ClinOrthop. 1988;230:39-48.
23. Nattrass GR, King GJ, McMurtry RY, Brant RF. An alternative method for determination of the carpal height ratio. J Bone Joint Surg Am. 1994;76:88-94.
24. Youm Y, McMurtry RY, Flatt AE, Gillespie TE. Kinematics of the wrist. I. An experimental study of radio-ulnar deviation and flexion-extension. J Bone Joint Surg Am. 1978;60:423-31.
25. Sanders RA, Keppel FL, Waldrop JI. External fixation of distal radial fractures: results and complications. J Hand Surg [Am]. 1991;16:385-91.