Outcome of Augmented External Fixation of Unstable Distal Radius Fractures

Abstract

Background: Well-reduced unstable distal radius fractures have the potential to undergo late displacement and/or collapse due to musculotendinous forces. To over come this there is controversy as to which is the preferred treatment – minimally invasive like external fixation or invasive like open reduction and plating. Objective: To determine the outcome of augmented external fixation of unstable distal radius fractures.  Design: Prospective study. Setting: Orthopedic surgery department of Independent Medical College, Punjab Medical College and University Medical College Faisalabad. Period: Between January 2009 and December 2010.Methods: In this case series study 46 patients with unstable distal radius fractures were    followed for 1 year after operation using the technique of application of common 3.5mm AO external fixator using principle of ligamentotaxis for reduction and restoring length with addition of k-wires plus bone graft if needed. All patients were evaluated according to the sum of demerit points system (Saito, 1983). Results: There were 20 male (43.48%) and 26 females (56.52%) with mean age 48.54+16.36. According to the sum of demerit points (Saito, 1983), the latest follow-up functional end results were ‘Excellent’ in 45.66%, Good in 34.78%, Fair in 10.87% and Poor in 08.69%. As for the anatomical results at follow-up, the radial shortening <2mm in 37 (70.44%), from 2-4mm in 5 patients (10.87%) and >4mm in 4(08.69%). The average radial tilt was 22°and palmar tilt was 6°. Conclusions: The application of common 3.5mm AO external fixator with addition of k-wires is simple, cost effective, quick, minimally invasive and prevents redisplacement of fracture fragments adequately. The risk of infection is small and there is little damage to the surrounding tissues.