COMPRESSION-FLEXION WRIST FRACTURES: 96 WRISTS WITH MEAN FIVE-YEAR FOLLOW-UP

Abstract

Purpose: Publications reporting compression flexion fractures are rather old and rarely individualise this type of fracture. There is a consensus on anterior plate fixation which generally provides good outcome. We propose a retrospective analysis of our series to revisit the classification system and analyse outcome after surgical treatment.

Material and methods: From January 1983 to November 2001, 96 fractures of the lower extremity of the radius with anterior displacement were treated in our unit. There were 95 patients (50 men and 45 women), mean age 42.7 years (15–88). The fracture resulted from a traffic accident in 52 patients. Twenty-seven patients had associated injuries. For lateral simple or complex anterior marginal fractures, the Castaing and Cauchoix classification was modified to take into account the importance of the fragment, relative to the middle of the radial glenoid, with or without associated lesion of the radial borders on the lateral and AP views (types I and II fractures). Type III factures were Goyrand fractures and type IV associated Goyrand fractures with one or more joint fracture lines. Our series thus included 43 anterior marginal fractures including 27 type II fractures where more than 50% of the joint surface was displaced, 53 Goyrand fractures (25 type III and 28 type IV). Plate fixation was used for 90 wrists, associated with complementary fixation in 17. Outcome was assessed with Laulan clinical criteria and Mouilleron radiological criteria.

Results: Bone healing was achieved in all cases, without changing the initial fixation in 85 wrists. There were 49 men and 35 women, mean age 40.7 years (20–87). Type I/II fractures were found in 40 wrists, simple Goyrand fracture (type III) in 23 and comminuted Goyard fracture (type IV) in 22. At three months, reduction was good in 57 cases (67%), fair in 23 and poor in five.There were eleven secondary displacements in eight women and three men, mean age 57.7 years. They had four type I/II fractures and seven Goyrand fractures (1 type III, and 6 type IV). Plate fixation used for eight wrists had to be completed with pinning or a fixator. Radiological reduction was good in two cases (18%), fair in three and poor in six (55%). Twenty-five patients (30%) presented residual pain (10 patients), carpal tunnel syndrome (7 patients), wrist or finger stiffness (4 patients), radiocarpal osteoarthritis (3 patients), and cutaneous palmar neuroma (1 patient). At mean 61 follow-up (12–204), clinical outcome was good for 70 wrists; 78 wrists were pain free. The radiological outcome was good in 64 wrists, fair in 18 and poor in five.

Discussion: Better radiographic analysis distinguishing type II and IV fractures, which were the cause of three-quarters of the displacements, improves identification of wrists which must have complementary fixation with pins or fixator in addition to the anterior plate which in these cases should be prebent. For the other wrists, initial reduction was satisfactory in 67%, explaining the good functional tolerance demonstrated subjectively (89%) and objectively (80%). There were only rare sequelae in this series and complications were limited: painful wrist in 10%, secondary to reflex dystrophy in two.

Conclusion: Good interpretation of the radiographs enables prediction of difficult reduction where complementary fixation in addition to the anterior plate can be useful for type II and IV fractures.