217. COMMINUTIVE FRACTURE OF THE DISTAL RADIUS IN THE ELDERLY SUBJECT: IS THERE STILL ROOM FOR EXTERNAL FIXATION? RETROSPECTIVE ANALYSIS OF 44 CASES

Abstract

Purpose of the study: Treatment of comminutive fractures of the distal radius in elderly subjects remains a debated issue. Use of locked plates has given interesting results, particularly in the young subject. External fixation remains the simple osteosynthesis technique with the advantage of being minimally invasive and well adapted to the quality of bone in the elderly subject. The purpose of this work was to evaluate the mid-term results of a series of radiometacarpal joint bridgings of comminutive fractures of the distal radius.

Material and methods: From January 2003 to December 2007, 44 radiometacarpal fixations were assemblied and included in a retrospective radioclinical study. All of the fractures were comminutive (AO classification: C2 20.4%, C3 79.6%) in subjects aged over 60 years. Surgery consisted in a radiocarpal assembly alone (25%) or associated with another fixation (75%). The PRWE score was used for the functional assessment and the Sofcot 2000 symposium criteria for the radiographic analysis. Factors of poor prognosis were studied.

Results: Forty-four patients were reviewed with a mean follow-up of 28 months. Five patients were lost to follow-up. All patients had healed at mean 6.8 weeks. The functional outcome was good or very good in 45.4% of patients. Radiographically, anatomic restitution was achieved in 15.9% with a moderate to severe callus deformity in 84.1%. Fifteen complications were noted: reflex dystrophy (n=5), neuroma (n=2), material migration (n=6), disassembly with surgical revision (n=2) and superficial infection (n=2).

Discussion: Unlike observations in the young subject, there does not appear to be a consensus on the treatment of comminutive fractures of the distal radius in the elderly osteoporotic subject. External fixation has been used for many years for comminutive fractures. Our results nevertheless illustrate the limitations of this technique, both in terms of the functional outcome (54.6% insufficient results) and radiographic outcome (84.1% callus deformities). The only good results obtained with the external fixator occurred when the technique was associated with another fixation method. This suggests we should consider fixation of the wrist as a temporary osteosynthesis which should be replaced by another method (locked plating).