TWENTY COMPLEX FRACTURES OF THE DISTAL RADIUS TREATED BY EXTERNAL FIXATION AND COMPLEMENTARY OSTEOSYNTHESIS

Abstract

Purpose: We report a retrospective analysis of 20 patients with complex fracture of the distal radius treated in an emergency setting with an external fixation and complementary osteosynthesis.

Material and methods: These 20 patients, mean age 43 years, fifteen men and five women were treated between January 1998 and November 2000. The dominant limb was involved in 16 cases. There were ten manual labourers and four patients who had regular sports activities. The surgical procedure included manual reduction then application of an external fixator (Orthofix). The second time was for insertion of an anterior plate in nine cases. For seven patients, pinning was associated with the plate. Only eleven patients were treated with external fixation and pinning alone. Mean hospitalisation was ten days. Active rehabilitation of the fingers included daily exercises. All external fixators had been removed on day 45.

Results: Mean follow-up was 22 months. Clinically, mean outcome was: palmar flexion 40°, dorsal flexion 36°, radial inclination 12°, ulnar inclination 15°, pronation 75°, supination 62°. Force was often less than 20% of the contra-lateral side. Radiologically, mean results were: on the AP view radial tilt 23°, radioulnar distance +1 mm, mean radial; and on the lateral view, radial tilt −1.4°. Bone healing was achieved on day 45. Two patients developed severe reflex dystrophy. There were no infectious or skin complications. Two patients developed a carpal tunnel syndrome. The plate was removed in two cases. Two patients developed palmar dysaethesia. Two patients had a complementary procedure on the distal radioulnar joint due to defective supination. Eleven patients resumed their occupational activities at a mean six months.

Discussion: The purpose of this analysis was to determine, retrospectively, the role of external fixation of the wrist associated with complementary osteosynthesis in patients with complex fractures of the distal radius. These extra- and intra-articular fractures are difficult to treat and require minute analysis. Outcome in our patients indicated that this analysis is often incomplete before treatment. We had four patients with a stair-step joint surface due to defective primary reduction. The radius was usually well reduced in the frontal plane but the sagittal plane was rarely corrected. The radioulnar distance evolved unfavourably in eight patients reaching > +2mm. Our poorest results were in cases with external fixation and pinning. The best results were obtained with combined treatment using a plate, pins and the external fixator.

Conclusion: We advocate a very careful and rigorous analysis of the fracture, in agreement with the SOFCOT 2000 symposium concerning complex fractures, and prefer a triple surgical procedure using a plate, pins and the external fixator.