DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20171495

Surgical management of fractures of distal end radius using uniplanar external fixator augmented with percutaneous kirschner wire fixation

H. B. Shivakumar, T. S. Channappa, Sushma C., Manju Jayaram

Abstract


Background: Distal end radius fractures is one of the most common fractures of the upper limb especially in the elderly population, accounting for about 17% of all upper limb fractures. Surgical stabilization of these fractures remains a challenge even today. Although the recent trend is towards internal fixation with locking plates, the external fixator itself has its own advantages in the treatment of these fractures.

Methods: This study is a prospective, time bound, hospital based study conducted in Kempegowda Institute of Medical Sciences and Research Center, Bangalore, between November 2014 to April 2016. The study included 30 cases of distal end radius fractures that were operated with the closed reduction and uniplanar external fixator augmented with k-wire for distal end radius by the principle of ligamentotaxis.

Results: In our study, 14 (46.6 %) patients had excellent results. Whereas, 11 (36.7%) patients had good results and 3 (10%) had fair and only 2 (6.7%) patients had poor results. Most of the fractures united by 12 weeks. Complications associated with the study was stiffness, malunion, sudeck’s  osteodystrophy and pin tract infection.

Conclusions: The uniplanar external fixator augmented with k-wire is a good choice in the treatment of distal end radius fractures  in terms of providing a good functional outcome if proper preoperative planning, good reduction and surgical technique are followed, leading to high rate of bone union, minimal soft tissue damage and complications.


Keywords


Distal end radius, Uniplanar external fixator, Modified Green O’Brien score

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References


Colles A. On the fracture of the carpal extremity of the radius. Edinburgh Med Surg. 1814;10:182–6.

US Department of Commerce EaSA, Bureau of the Census. Bureau of the Census: Statistical abstract of the United States. 1995.

Melton L. Epidemilogy of fractures. In: Riggs BL ML, editor. Osteoporosis: etiology, diagnosis, and management. New York: Raven Press; 1988: 133-154.

Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand. 1985;56:391-3.

Larsen CF, Lauritsen J. Epidemiology of acute wrist trauma. Int J Epidemiol. 1993;22:911-6.

Bacorn RW, Kurtzke JF. Colles’ fracture; a study of two thousand cases from the New York States Compensation. J Bone Joint Surg Am. 1953;35(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.

DePalma AF. Comminuted Fractures of the Distal End of the Radius Treated by Ulnar Pinning. J. Bone and Joint Surg. 1952;34:651-62.

Deepak CD, Gopalakrishna G, Ravoof A, Vijay C, Mohan JA. Surgical management of distal end radius fractures by ligamentotaxis. Int J Health Sci Res. 2014;4(4):106-10.

D’Anca AF, Sternlieb SB, Byron TW, Feinstein PA. External fixator management of unstable Colles’ fractures: an alternative method. Orthopedics. 1984;7:853-9.

Jakim I, Pieterse HS. External fixator for intra articular fracture of the distal radius. J Bone Joint Surg. 1991;73-B:302-6

Yalavarthi RK. Outcome of management of distal radius fractures by ligamentotaxis. IOSR. 2015;14(7):33-7.

Steffen TH, Eugster T, Jakob RP. Twelve years follow-up of fractures of the distal radius treated with the AO external fixator. Injury. 1994;25:44-54.

Ricciardi L. The external fixation treatment of distal articular fractures of the radius. Orthopedics. 1984;7(4):637-41.

Barbu D, Popescu GH, Putineanu D. The value of external fixator in distal radius fracture. Am J Clin Med. 2007;2(3):207-13.

Ma C, Deng Q, Pu H, Cheng X, Kan Y, Yang J, et al. External fixation is more suitable for intra articular fractures of the distal radius in elderly patients. Bone Res. 2016;4:1601-7.

Clyburn TA. Dynamic External Fixation for Comminuted Intra-Articular Fractures of the Distal End of the Radius. J Bone and Joint Surg. 1987;69:248-54.

Frykman GK. Fracture of the distal radius including sequelae shoulder hand finger syndrome. Disturbance in the distal radioulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand Suppl. 1967;108:1–155.

Cooney WP, Linscheid RL, Dobyns JH. External Pin Fixation for Unstable Colles' Fractures. J Bone Joint Surg. 1979;61:840.