Abstract
Introduction The purpose of this paper is to describe our management of complex fractures of the distal radius and ulna using a combined type of stabilization, external with a Pennig fixator, internal with radial augmentation with plate. The patient have substained a several general trauma or an high energy scheletral trauma upper limbs.
Treatment In a period from 24 july 2002 to today 8 october 2004 (26 months) we have treated surgically 93 wrists with distal radial fractures in 85 patient.
4 patients bilaterally, 3 patients have substained a secondary reprease for lacking the initial reduction and 2 in two programmed timing.
46 wrists with radial internal fixation single or double plate (in one case trhee plate)
12 plate with pin or single screw in augmentation
3 cases with only screw artroscopically assisted
14 cases with only external fixator with or without pin
18 wrist with a combination of radial internal fixation (plate) and external fixation with Pennig, in complex distal radial-ulna fracture (2 exposed)
In 5 wrists there were associated and treated navicular fracture or intracarpal ligaments injury
1 pazient have sustained an ipsilateral forearm fracture, epiphiseal distal radial fracture, trans scapho-lunate dislocation and controlateral transcapho-lunate dislocation
1 patient have sustained ipsilateral navicular-fisrt metacarpal-radial and ulna fracture
The most patients (...) have been treated from the first Author.
The patients were controlled from minimum of 6 month up a maximum of 39 months
We have adapted in our evaluation the Dash score system
The main problem, in the follow up results is a lack of prono-supination that stresses the importance of a perfect reduction of distal radio-ulnar joint to begin early a phisiotherapy
Clinical results In conclusion our experince in timing of treatment indicate that is important fixate the lesions earlier, whenever the priority of treatment on severly injured pazients are respected
We believe that a combination of the two fixation system allow an optimal external stabilization in the first week (So the terapist can move the patients in intensive care room). Secondary the internal fixator allows an anatomical reduction with a stable fixation in the secondary kinesiterapeutic time protocol of high energy trauma to distal forearm, in particular in politraumatized patients is:
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- closed reduction and short cast or external fixator if exposed or severe instable, on the day of injury during or just following generally stabilization
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- if possible e Tc 3D dimensional scan (our patients have substained a lot of tc scan for other trauma)
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- internal reduction and stabilitation a fews days later when the local swelling or skin damage and general condition allow it (from 2 to 7)
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- removal of external fixator between 3–4 week and begin a complete fkt
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
