DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20193833

Functional outcome of distal radius fractures treated with fixation by percutaneous cannulated screw

Prakash Kumar, Ashok Desai, Harshal Patkar, Deepak Phalgune

Abstract


Background: In the present study primary objectives were to evaluate the clinical and functional outcome and union rates, whereas secondary objective was to study complications associated with closed reduction percutaneous fixation of displaced unstable fractures of distal radius in adults by using cannulated cancellous (CC) screw.

Methods: Thirty two patients aged more than 18 years, with unstable displaced distal radial fracture were included in this prospective observational study. Patients were treated by closed reduction and percutaneous fixation by CC screw. Radiological parameters like radial inclination, radial height, ulnar variance, volar tilt were measured. Mayo wrist score and range of motion were noted. Patients were followed up for six months. Continuous variables were compared by using paired and unpaired ‘t’ test.

Results: Mean Mayo wrist score at six months post-operative follow-up (82.8) was significantly higher compared to six weeks post-operative follow-up (64.4). Mean early post-operative radial height, mean radial inclination, and mean volar tilt were significantly higher compared to mean six months post-operatively. Mean early post-operative ulnar variance was significantly lower compared to mean six months post-operatively. Mean flexion, mean extension, mean supination, mean pronation, mean radial deviation, and mean ulnar deviation was significantly higher six months post-operative follow-up compared to six week post-operative follow-up. Mean grip strength was significantly higher six months post-operative follow-up compared to six week post-operative follow-up.

Conclusions: Clinical and functional outcomes associated with closed reduction and percutaneous fixation by cannulated cancellous screw was excellent. Mayo wrist score was increased over six months follow up period.


Keywords


Distal radius fractures, Percutaneous cannulated screw, Fernandez classification, Frykman classification, Mayo wrist score, Grip strength

Full Text:

PDF

References


Jakim I, Pieterse HS, Sweet MB. External fixation for intra-articular fractures of the distal radius. J Bone Joint Surg.1991;73:302-6.

Hollingsworth R, Morris J. The importance of ulnar side of wrist in fracture of distal radius. Injury. 1975;7:263-6.

Linschied RL. Kinematic considerations of the wrist. Clin Orthop Relat Res. 1986;202:27-39.

Colles A. On the fracture of the carpal extremity of the radius. N Engl J Med Surg. 1814;3:368-72.

Ark J, Jupiter JB. The rationale for precise management of distal radius fractures. Orthop Clin North Am. 1993;24(2):205-10.

Swiontkowski MF. Increasing Rates of Forearm Fractures in Children. JAMA. 2003;290:3193.

Bacorn RW, Kurtzke JF. Colles' fracture. J Bone Joint Surg. 1953;3:643-58.

Fernandez DL. Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg. 1982;64:1164-78.

Zemel NP. The prevention and treatment of complications from fractures of the distal radius and ulna. Hand Clin. 1987;3:1-11.

Sarmiento A, Pratt GW, Berry NC, Sinclair WF. Colles' fractures. Functional bracing in supination. J Bone Joint Surg. 1975;57:311-7.

Jupiter JB. Current concepts review: fractures of the distal end of the radius. J Bone Joint Surg. 1991;73:461-9.

Botte MJ, Davis JL, Rose BA, von Schroeder HP, Gellman H, Zinberg EM et al. Complications of smooth pin fixation of fractures and dislocations in the hand and wrist. Clin Orthopaed Rel Res. 1992;276:194-201.

Hsu LP, Schwartz EG, Kalainov DM, Chen F, Makowiec RL. Complications of K-wire fixation in procedures involving the hand and wrist. J Hand Surg. 2011;36:610-6.

Simic PM, Weiland AJ. Fractures of the distal aspect of the radius: changes in treatment over the past two decades. J Bone Joint Surg. 2003;85:552-64.

Payandeh JB, McKee MD. External fixation of distal radius fractures. Orthop Clin N Am. 2007;38:187-92.

Kaempffe FA, Wheeler DR, Peimer CA, Hvisdak KS, Ceravolo J, Senall J. Severe fractures of the distal radius: effect of amount and duration of external fixator distraction on outcome. J Hand Surg. 1993;18:33-41.

Weber SC, Szabo RM. Severely comminuted distal radial fracture as an unsolved problem: complications associated with external fixation and pins and plaster techniques. J Hand Surg. 1986;11:157-65.

Anderson JT, Lucas GL, Buhr BR. Complications of treating distal radius fractures with external fixation: a community experience. Iowa Orthop J. 2004;24:53-9.

Duncan SF, Weiland AJ. Minimally invasive reduction and osteosynthesis of articular fractures of the distal radius. Injury. 2001;32:14-24.

Gerostathopoulos N, Kalliakmanis A, Fandridis E, Georgoulis S. Trimed fixation system for displaced fractures of the distal radius. J Trauma Acute Care Surg. 2007;62:913-8.

Gereli A, Nalbantoglu U, Kocaoglu B, Turkmen M. Comparative study of the closed reduction percutaneous cannulated screw fixation and open reduction palmar locking plate fixation in the treatment of AO type A2 distal radius fractures. Arch Orthopaed Trauma Surg. 2014;134:121-9.

Lozano-Calderón SA, Doornberg JN, Ring D. Retrospective comparison of percutaneous fixation and volar internal fixation of distal radius fractures. Hand. 2008;3:102-10.

Levin LS, Rozell JC, Pulos N. Distal radius fractures in the elderly. J Am Acad Orthop Surg. 2017;25:179-87.

Wei DH, Poolman RW, Bhandari M, Wolfe VM, Rosenwasser MP. External fixation versus internal fixation for unstable distal radius fractures: a systematic review and meta-analysis of comparative clinical trials. J Orthopaed Trauma. 2012;26:386-94.

Engles D. Use of cannulated screws in hand and wrist surgery. In: Capo JT, Tan V (eds). Atlas of Minimally Invasive Hand and Wrist Surgery. CRC Press; 2007: 29-35.

Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney WP, Linscheid RL. Scaphoid malunion. J Hand Surg. 1989 ;14:679-87.

Tank G, Gupta AK, Ahmed P, Singh G, Jaiswal S, Anish K. Anatomical and functional evaluation of distal end radius fractures managed by volar plating: a prospective study. J Evol Med Dental Sci. 2013;2:802-11.

Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35:121-6.

Nalbantoglu U, Gereli A, Kocaoglu B, Turkmen M. Percutaneous cannulated screw fixation in the treatment of distal radius fractures. Arch Orthop Trauma Surg. 2012;132:1335-41.

Patil MS, Khan MW, Mallick FA. 4 mm cannulatedcancellous screws fixation in extra articular distal 1/3 radius fracture-A study. Al Ameen J Med Sci. 2017;10:49-55.