CORRELATION BETWEEN POSTTRAUMATIC OSTEOARTHRITIS AND FUNCTIONAL DISORDERS OF THE WRIST IN COMMINUTED INTRARTICULAR FRACTURES AFTER EXTERNAL FIXATION

Abstract

Introduction: The aim of this study is to correlate the long-term functional outcome of the wrist joint to the establishment of radiological osteoarthritic disfigurements that develop after treating comminuted intrarticular fractures of the distal radial epiphysis with external fixation.

Materials and Methods: Forty patients (22 male and 18 female) aging between 19 and 72 y.o who suffered a comminuted intrarticular fracture of the distal radial epiphysis from 1996 to 2002 and were treated with external fixation. The follow up started in 1996 and ended in 2007 (m.t 8 years). The fracture pattern was classified according to the Melone classification, the osteoarthritis stage according to the radiological findings and the functional outcome according to PRWE and UEFS forms.

Results: From 40 overall patients, twenty seven (67,5%) were classified as Melone II fracture pattern, nine (22,5%) as Melone III and four (10%) as Melone IV. In addition, 15% (6 pts) developed stage I osteoarthritic disfigurements, 45% (18 pts) stage II, 25% (10 pts) stage III and 15% (6 pts) stage IV. It’s quite remarkable the fact that among the patients with Melone II fracture pattern, 22,2% developed stage I osteoarthritis, 55,5% stage II and 11,1% stage III and IV respectively. The patients with Melone III fracture pattern developed stage II, III and IV osteoarthritis in a percentage of 33,33%. All the patients with Melone IV fracture pattern developed stage III osteoarthritis. The PRWE wrist evaluation form showed that 77,5% of the patients scored equal or less than 10/150 and 22,5% between 11/150 and 30/150. The UEFS wrist evaluation form showed similar results with 62,5% score of 8/80 and 27,5% score between 9/80 and 14/80. As final result, it seems that the development of osteoarthritis does not affect the functional outcome of the wrist in 95% of the patients whereas the rest 5% experienced minor or moderate wrist joint impairment.

Discussion and Conclusions: Fractures that are either unstable and/or involve the articular surfaces can jeopardize the integrity of the articular congruence and/or the kinematics of these articulations. However, the limitation of external fixation to achieve articular congruity in the comminuted intra-articular fractures of the distal radius has been documented in the literature. The fracture pattern, the degree of displacement, the stability of the fracture and the age and physical demands of the patient determine the best treatment option.

In addition, it seems that the radiological findings do not walk along with the clinical features and the wrist functionality in a major percentage. Our results indicate the importance of anatomical reduction and especially the restoration of radial length in order to obtain good functional future outcome.