A comparative study of functional outcome of treatment of intra-articular fractures of distal end radius fixed with external fixator vs. volar plate
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20193841Keywords:
Distal end radius fracture, External fixation, Volar plate, Modified Green and O’Brien scoreAbstract
Background: Distal end radius fractures constitute 75% of all forearm fractures. Maintenance of the articular congruity is an ardent prerequisite for successful recovery, following distal end radius fractures. The available options include immobilization with plaster, external fixation, prefabricated splintage using ligamentotaxis, K-wire fixation, and open reduction internal fixation with various plates. The aim of the study was to analyze and compare the functional outcome and possible complications associated with fixation of two different surgical modalities: External fixator and Volar Plate in the treatment of intra-articular fractures of distal end radius.
Methods: A prospective comparative study was conducted in 26 patients who were admitted and operated between September 2017 to September 2018 and had fulfilled the inclusion /exclusion criteria. They were allocated into 2 groups-group A and B, 13 patients each for external fixator and open reduction and internal fixation with volar T plate, respectively.
Results: The results were assessed using the modified Green O’ Brien Scoring. In Group-A of patients treated with External fixator we had 6 excellent, 3 good, 3 fair results and 1 poor results. Whereas in Group-B of ORIF with Volar plating we had 7 excellent, 3 good, 2 fair results and 1 poor results.
Conclusions: In our study, volar plate fixation showed superiority as it provides better long term functional outcome owing to more adequate restoration of radio-ulnar variance and distal end radius parameters.
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References
Forward DP, Lindau TR, Melsom DS Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am. 2007;89:2334-40.
Leung F, Tu YK, Chew WY, Chow SP. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study. J Bone Joint Surg Am. 2008;90(1):16-22.
Richards RR. Fractures of the shafts of the radius and ulna. In. Bucholz RW, Heckman JD, editors. Rockwood and Green’s fractures in adults. 5th edition. Philadelphia, USA: Lippincott Williams and Wilkins; 2001: 869-917.
Simic PM, Weiland AJ. Fractures of the distal aspect of the radius: Changes in treatment over the past two decades. Instr Course Lect. 2003;52:185-95.
Gradl G, Gradl G, Wendt M, Mittlmeier T, Kundt G, Jupiter JB. Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius. Arch Orthop Trauma Surg. 2013;133(5):595–602.
Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury. 2000;31:75–9.
Haddad M, Jacoby B, Snerum L, Hede J, Overgaard S. External fixation of distal radial fractures: 3 or 5 weeks of external fixation. Int Orthop. 2000;24:224-6.
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 Am. 1993;18:33-41.
Kaempffe FA, Walker KM. External fixation for distal radius fractures: Effect of distraction on outcome. Clin Orthop Relat Res. 2000;380:22025.
McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomized comparison of four methods of treatment. J Bone Joint Surg Br 1996;78:404–9.
Schmelzer-Schmied N, Widloch P, Martini AK, Daecke W. Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly. Int Orthop. 2009;33:773–8.
Dobretz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop. 2003;27:1–6.
McQueen MM, Hajducka C, Court- Brown CM: Redisplaced unstable fractures of the distal radius: A prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br 1996;78:404-9.
14. Allain J, le Guilloux P, Le Mouël S, Goutallier D: Trans-styloid fixation of fractures of the distal radius: A prospective randomized comparison between 6- and 1-week post-operative immobilization in 60 fractures. Acta Orthop Scand. 1999;70:119-23.
Lozano-Calderón SA, Souer S, Mudgal C, Jupiter JB, Ring D: Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am. 2008;90:1297-304.
Chung KC, Squitieri L, Kim HM. Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years. J Hand Surg Am. 2008;33:809-19.
Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004;29:96-102.
Ginn TA, Ruch DS, Yang CC, Hanel DP. Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. Surgical technique. J Bone Joint Surg Am. 2006;88(1):29-36.
Hanel DP, Lu TS, Weil WM. Bridge plating of distal radius fractures: the Harborview method. Clin Orthop Relat Res. 2006;445:91-9.
Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch DS. Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg Am. 2012;37:948-56.