Abstract
Purpose of the study: Treatment of distal fractures of the radius with posterior displacement remains a controversial issue. In the past, the anterior approach used for osteosynthesis failed to enable sustained reduction. With the recent development of locked plating systems, it might be useful to revisit this technique.
Material and methods: Between November 2001 and April 2003, 23 patients (15 females, 8 males), mean age 55 years (range 17–75 years) were treated with an LCP 3.5 T plate (Mathys Medical SA, Bettlach, Switzerland). The anterior Henry approach was used. There were 16 extra-articular fractrures and seven with an associated intra-articular fracture line. Radiographic analysis searched for secondary displacement and was coupled with clinical examination with force measurement (DASH). The Herzberg score used for the SOFCOT 1999 symposium was noted.
Results: Eighteen patients were reviewed with mean follow-up of 16 months. Radiologically, all fractures had healed at twelve months, with only one case of secondary loss of reduction. According to the SOFCOT symposium criteria, bone healing was anatomic for 13 cases and with moderate misalignment for five. Wrist force (Jamar) on the operated side was 95% of the opposite side. The mean DASH was 22.7. The Herzberg outcome was: excellent (n=9), good (n=6), fair (n=3), and poor (n=0). Complications were: reflex dystrophy (n=4), carpal tunnel syndrome (n=1), cheloid scar (n=1), irritation of the common extensor of the fingers (n=1).
Discussion: Secondary displacement after fracture of a posteriorly displaced fracture of the distal radius frequently lead to misalignment which is often poorly tolerated. The LCP system maintains a stable reduction long enough to reduce the rate of secondary displacement.
Conclusion: A comparative study of the commonly applied techniques (pinning) would be necessary to define the appropriate indications for this more costly technique.
Correspondence should be addressed to SOFCOT, 56 rue Boissonade, 75014 Paris, France.
