TREATMENT OF FRACTURES OF THE DISTAL END OF RADIUS BY DELAYED EXTERNAL FIXATION

Abstract

Introduction : External fixation is a good alternative method for fractures of the distal end of radius that are not manageable for closed treatment. It is a simple technique, and has proved to be safe and effective in our experience.

Material and Methods: We present 25 patients with 26 fractures of the distal end of radius (age 32 to 85, avg 57 yrs) which were treated by external fixation during the last 4 years. Eight fractures were in polytrauma patients, 16 were unstable and one patient had bilateral fractures. According to Frykman classification 2 were in type II, 5 in type IV, 2 in type V, 5 in type VI, 4 in type VII and 8 in type VIII.

The time of surgical treatment since the date of fracture ranged from 9–15 days (avg 12 days) .We used Pennig’s fixator in 22 cases and Citieffe fixator in 4 cases.

Results: All patients were followed up for 8 to 42 months (mean 27, 7). Clinical union was established at an average of 6.5 weeks following the fracture. There was one infection of the distal pins, 2 cases with algodystrophy, but no malunion. For assessment of the anatomical result we used the Sarmiento and Latta modification of the Lidstrom classification: 16/26 (61.5%) were excellent, 8/26 (30.7%) good, 1/26 (3,87%) fair and 1/26 (3.87%) poor.

Conclusion: In comminuted, badly displaced fractures of the distal end of radius, the upper extremity following initial closed manipulation and application of plaster is characterized by a decrease in finger mobility, oedema, and large mass of bandaging. Instability of the fracture nad poor result is expected as soon as the oedema subsides. Alternatively, an external fixator is applied after remission of the edema and before two weeks from the fracture date, so to the fracture is easily reducible. With the delay in fixator application we avoid reduction difficulty and pin infection as the oedema has subsided, we have time to explain everything to the patient and organize the operation . This delay in the application of external fixation in distal fractures of the radius is favored in our department because of the low complication rate, excellent or good (92%) functional results, easy and safe approach.