Purpose of the study: Fractures of the distal radius have been underestimated by specialists. Several authors have reported serious functional sequelae resulting from incorrect treatment of these fractures. Treatment of these fractures has now been improved significantly thanks to correct interpretation of the pathogenic mechanisms and factors of instability and to the establishment of a correct classification enabling adequate surgical treatment.
Material and methods: Over the last five years (1994–2005) we have treated more than 600 fractures of the distal radius. Among these, we evaluated 480 treated at the Eva-Peron hospital and in our private clinic in Rosario. An original system of radio-radial external fixation was the only treatment to final bone healing. The system enables immediate mobilization of the articulation, favoring rapid rehabilitation and improving patient comfort. Taking into account the distinct factors of instability, basically five factors, we developed a simple classification system which accounts for not only the pathophysiology of these fractures but also indicates the appropriate treatment.
Results: Considering our series of 480fractures followed for 18 months, the Green and O’Brien system noted: among 180 patients with extra-articular fractures, excellent and good outcome in 171 (95%) and fair outcome in 8 (5%); among 300 patients with intra-articular fractures, excellent and good outcome in 279 (93%) and fair outcome in 21 (7%). Factors of stability were as classically noted:
comminution of the dorsal wall;
anterior wall damage deeper than 2 mm;
intra-osseous cavitation due to a crushed medullary canal. Two other instability factors were observed:
comminution of the medial wall of the radius;
free styloid process disconnected from the articular fragment. The classification system was as follows.
Fractures without dislocation. Fractures with dislocation 1) extra-articular: ligamentotaxy + pinning + cast or ligamentotaxy + pinning + radioradial fixator. 2 intra-articular.
Type I: without comminution of the medial wall, styloid process connected to the articular fragment: ligamentotaxy + pinning + cast or ligamentotaxy + pinning + radioradial fixator.
Type II: with comminution of the medial wall, «free» styloid process: open surgery (reduction and stabilization), bone grafts for osteodesis or osteosynthesis, plating + bone grafts (as needed) with a metacarpal radio-radial fixator.
Type III: complex comminutions, radioradial fixator, 2nd metacarpal (formal indication).
Discussion: We consider that if the instability factors are taken into account, these fractures can be classified correctly. This enables proper reduction ans adequate stabilization, usually without open surgery in the majority of patients. Outcome is highly satisfactory and open surgery can be used when unavoidable.
