Correlation between patient health questionnaire-2 and postoperative pain in laparoscopic cholecystectomy

Background@#Postoperative pain is affected by preoperative depression. If the risk of postoperative pain associated with depression can be predicted preoperatively, anesthesiologists and/or surgeons can better manage it with personalized care. The objective of this study was to determine the efficacy of Patient Health Questionnaire-2 (PHQ-2) depression screening tool as a predictor of postoperative pain. @*Methods@#A total of 50 patients scheduled for elective laparoscopic cholecystectomy with an American Society of Anesthesiologists grade of 1 or 2 were enrolled. They answered the PHQ-2, which consists of two questions, under the supervision of a researcher on the day before the surgery. The numerical rating scale (NRS) scores were assessed at post-anesthesia care unit (PACU), at 24, and 48 postoperative hours, and the amount of intravenous patient-controlled analgesia (IV-PCA) administered was documented at 24, 48, and 72 postoperative hours. At 72 h, the IV-PCA device was removed and the final dosage was recorded. @*Results@#The NRS score in PACU was not significantly associated with the PHQ-2 score (correlation coefficients: 0.13 [P = 0.367]). However, the use of analgesics after surgery was higher in patients with PHQ-2 score of 3 or more (correlation coefficients: 0.33 [P = 0.018]). @*Conclusions@#We observed a correlation between the PHQ-2 score and postoperative pain. Therefore, PHQ-2 could be useful as a screening test for preoperative depression. Particularly, when 3 points were used as the cut-off score, the PHQ-2 score was associated with the dosage of analgesics, and the analgesic demand could be expected to be high with higher PHQ-2 scores.

Effect of the lateral tilt position on femoral vein cross-sectional area in anesthetized adults

BACKGROUND: A lateral tilt position can affect the size of the femoral vein (FV) due to increased venous blood volume in the dependent side of the body. METHODS: Forty-two patients, aged 20–60 years, were enrolled in this study. The crosssectional area (CSA), anteroposterior, and transverse diameters of the FV were measured 1 cm below the left inguinal line using ultrasound. The value of each parameter was recorded in the following four positions: (1) supine, (2) supine + 10° left-lateral tilt (LLT), (3) 10° reverse Trendelenburg (RT), and (4) RT + LLT. RESULTS: CSAs of the left FV in the supine, supine + LLT, RT, RT + LLT positions were 0.93 ± 0.22, 1.11 ± 0.29, 1.17 ± 0.29, and 1.31 ± 0.32 cm2, respectively. Compared to the supine position, there was a significant increase in CSA and anteroposterior diameter according to the three changed positions. The transverse diameter of the left FV was significantly increased in supine + LLT, RT, RT + LLT positions compared to that in the supine position (P = 0.010, P = 0.043, P = 0.001, respectively). There was no significant difference in the transverse diameter of the left FV between the supine + LLT and RT positions (P = 1.000). CONCLUSIONS: Adding LLT to the supine and RT positions increased the CSA of the unilateral FV significantly.

A Preliminary Survey on Clinical Practice for Children and Adolescents with Gender Dysphoria in Japan: Current Situation and Challenges

Little is known about the treatment of gender dysphoria among children and adolescents in Japan. This preliminary survey aims to improve understanding of current clinical practice for treatment of children with gender dysphoria. Subjects were 315 certified child and adolescent psychiatrists in Japan. The questionnaire asked about clinical experiences concerning gender dysphoria and gender identity-related concerns. A total of 128 psychiatrists responded to the questionnaire. Mean length of clinical experience was 24.2±10.0 years in total and 16.9±11.5 years as child and adolescent psychiatry specialists. Among the respondents, 74 (57.8%) had seen children and adolescents with DSM-5 gender dysphoria, and 87 (67.7%) had examined cases with gender identity-related concerns. The mean number of experienced cases with gender dysphoria was 1.80±2.3 per respondent. We found that even among certified child and adolescent psychiatrists in Japan, experience with treatment of children with gender dysphoria was limited.

Anaphylaxis occurred immediately after prophylactic antibiotics injection with negative intradermal skin test during laparoscopic cholecystectomy / 고신대학교의과대학학술지

Prophylactic antibiotics that are used to prevent post-operative infection can commonly cause anaphylactic reactions during anesthesia. It is therefore necessary to perform a skin test before antibiotics are administered in order to diagnose and prevent anaphylactic reactions. However, the results of the antibiotic skin test can differ according to the drug, dose, and reagent concentration. We report a case of anaphylactic shock with bronchospasm and cardiovascular collapse immediately following administration of the prophylactic cefazedone after induction of general anesthesia for laparoscopic cholecystectomy.

Percutaneous Vertebroplasty for Osteoporotic Compression Fractures / 대한정형외과학회잡지

PURPOSE: To evaluate the results of percutaneous vertebroplasty using PMMA (polymethylmethacrylate) in the treatment of osteoporotic compression fractures. MATERIALS AND METHODS: A retrospective review was conducted of 38 patients with 64 vertebrae treated by percutaneous vertebroplasty from June 1999 to May 2000. The patients had symptomatic, osteoporotic fractures and had failed medical therapy. Immediate and long-term pain responses and complications of the percutaneous vertebroplasty with PMMA were evaluated. RESULTS: Thirty-three (86.8%) of the 38 patients reported pain improvement within the first 48 hours. Seventeen (44.8%) were evaluated as excellent; eleven (28.9%), as good; six (15.8%), as fair; and four (10.5%), as poor. Fourteen (36.8%) patients had cement extrusion into a disc, paravertebral vessels or epidural space without significant systemic symptoms. CONCLUSION: Percutaneuos vertebroplasty using PMMA provided significant pain relief in a high percentage of patients with osteoporotic compression fractures. It is considered to be an alternative method of treating patients with osteoporotic compression fractures of vertebral bodies who do not respond to conservative treatment.

Arthroscopic ACL Reconstruction using Fresh Frozen Bone-patellar tendon-bone Allograft: short-term follow-up results / 대한정형외과학회잡지

PURPOSE: To evaluate the short-term (2 to 4 year) results of arthroscopic anterior cruciate ligament (ACL) reconstruction using fresh frozen bone-patellar tendon-bone allograft. MATERIALS AND METHODS: Forty-two cases were evaluated and the mean follow-up period was 38 months (27-49 months). Evaluation included the Lysholm score, the 2000 IKDC subjective knee score, the Lachman test, the pivot shift test, the KT-1000 arthrometer test and the 2000 IKDC knee examination. RESULTS: Thirty-six cases (85.7%) had excellent or good results according to the Lysholm score (mean, 89.2), and 36 cases (85.7%) had a 2000 IKDC subjective knee score of more than 70 (mean, 81.4). Thirty-nine cases (92.8%) were negative or 1+ (firm end-point) on the Lachman test and 40 cases (95.3%) were negative or 1+ on the pivot shift test. Twenty-seven cases (64.3%) had less than a 3 mm manual maximum difference and 12 cases (28.5%) were between 3 and 5 mm by the KT-1000 arthrometer test. Thirty eight cases (90.4%) were normal or nearly normal according to the 2000 IKDC knee examination. CONCLUSION: Arthroscopic ACL reconstruction using fresh frozen bone-patellar tendon-bone allograft resulted in a reliable and predictable outcome after 2 to 4 years of follow-up.

Heterotopic Ossification After Total Knee Arthroplasty

PURPOSE: To investigate the incidence, clinical and radiological courses of the heterotopic ossification following total knee arthroplasty (TKA). MATERIALS AND METHODS: We investigated the incidence, time of detection, location, symptom and treatment of the heterotopic ossification with retrospective study in 160 cases (111 patients) of primary TKA from Mar. 1997 to Sept. 2001. RESULTS: The incidence of the heterotopoic ossification was 3.8% (5 patients, 6 cases), the mean follow-up period was 20 months (12 months to 42 months). All of preoperative disagnosis was osteoarthritis. The average time of detection was 3.5weeks (2 weeks to 6 weeks) after operation. The sites of the heterotopic ossification were anterior cortex of distal femur in 5 cases, posterior cortex of distal femur in 3 cases, quadriceps expansion in 4 cases, the femoral attachment site of the MCL in 1 case and posterior compartment of knee in 1 case. The symptom was variable painful limitaion of motion. No specific treatment had been done except continuous passive or active motion exercise. The average preoperative range of motion was 20 degree to 110 degree and at last follow-up, the average range of motion was 5 degree to 105 degree with relief of pain. CONCLUSION: Although the heterotopic ossification following TKA is a rare complication, it should be suspected in patients with painful deterioration of motion between the second and sixth postoperative week. The relief of pain and the improvement of range of motion could be achieved with the lapse of time without specific treatment except continuous passive or active motion exercise.

Meniscus Hoop Tensioning Function of the Meniscofemoral Ligament: An Experimental Study Using the Knee Joint of the Pig

PURPOSE: To prove experimentally if the posterior meniscofemoral ligament (PML) has hoop tensioning function for the lateral meniscus using the knee joint of the pig. MATERIALS AND METHODS: Amputated stumps with the knee joint of the pig (Yorkshire) were used. The experiment was performed under 6 conditions; 1) intact PML with intact lateral meniscus (LM), 2) intact PML with radial tear of posterior horn of LM, 3) intact PML with total lateral meniscectomy, 4) cut PML with intact LM, 5) cut PML with radial tear of posterior horn of LM, and 6) cut PML with total lateral meniscectomy. The pressure-sensitive film (Prescale,Fuji) was inserted under the lateral femoral condyle and axial loads was transmitted to the knee joint with universal testing machine (Instron, model No.4469, USA). The pressed area, maximum pressure and average pressure were measured by the Prescale imaging analysis system FDP-901E series. RESULTS: With the intact PML, there was little difference in pressed area and maximum and average pressures between the conditions of intact meniscus and radial tear of posterior horn of LM. With the cut PML, regardless of the states of the LM, pressure concentration (much decreased pressed area, and increased maximum and average pressures) occurred, which had similar results to the condition of total lateral meniscectomy with intact PML. CONCLUSION: The PML of the pig had hoop tensioning function for the LM under axial loads.

Angiographic Embolization as a Treatment of Postoperative Bleeding / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of the angiographic embolization for the treatment of postoperative bleeding. MATERIALS AND METHODS: Six patients who suffered massive postoperative bleeding underwent angiographic embolization from March 1998 to June 1999. The initial diagnosis was femoral fractures in 4 patients, infected total hip arthroplasty in a patient, and open humerus fracture in a patient. When angiography revealed arterial tear, embolization was performed. The authors evaluated the effectiveness and the complication of angiographic embolization. RESULT: Five patients had arterial tear and one patient had diffuse bleeding from the granulation tissue. Angiographic embolization was performed in all patients. There were 3 cases of injury of the deep femoral artery, a case of injury of a branch of the subclavian artery, and a case of injury of the superior gluteal artery. After the procedure swelling subsided and the amount of transfusion diminished in all patients. There was no complication related to angiographic embolization. CONCLUSION: When there is suspicion of arterial injury after the operation, angiographic embolization can be used to confirm arterial injury and to control bleeding.

Posterior Epidural Migration of Herniated Lumbar Intervertebral Disc: Two Cases Report / 대한척추외과학회지

STUDY DESIGN: case report and review of the literature OBJECTIVES: to report two cases of posterior epidural migration of herniated lumbar intervertebral disc and review the literature Summary of Background Data : Posterior epidural migration of herniated lumbar intervertebral disc is extremely rare. The large size of the fragment eventually exceeded the limits of the anterior epidural space and the fragment subsequently settled posterior the thecal sac because of spatial and size constraints. MATERIALS AND METHODS: Two cases of herniation of intervertebral disc which were caused by posteriorly migrated disc material were treated surgically with open discectomy. The magnetic resonance images, surgical treatment and related literature are reviewed. RESULTS: Preoperative magnetic resonance images of the posterior epidural migration of herniated lumbar intervertebral disc showed a large epidural mass. The mass was of intermediate signal intensity on T1-weighted images, was of low signal intensity on T2-weighted images and was enhanced marginally with gadolinium-DTPA on T1-weighted images. Immediately after operation, a significant reduction of symptoms were achieved. The patients recovered fully at two year follow-up. CONCLUSIONS: Lumbar disc herniation by posterior epidural migration of sequestered fragment can be diagnosed with clinical findings and MRI including Gadolinium-DTPA enhancement. It should be differentiated from epidural mass and could be managed surgically with good results.

Kummell's Disease Managed by Percutaneous Vertebroplasty / 대한척추외과학회지

STUDY DESIGN: Prospective study about fourteen consecutive patients with Kummell's disease who were treated by percutaneous vertebroplasty with bone cement. OBJECTIVES: To evaluate the results of percutaneous vertebroplasty using bone cement in the treatment of Kummell's disease. SUMMARY OF LITERATURE REVIEW: Kummell's disease is a rarely reported, poorly documented, and poorly understood phenomenon. It is associated with intravertebral vacuum phenomenon and clinically manifested by painful kyphosis. The treatment of the disease had been conservative or surgical reconstruction, but both conservative and operative treatment were not satisfactory in some patients. MATERIALS AND METHODS: A review was conducted of 14 patients with 18 vertebrae treated with percutaneous vertebroplasty from June 1999 to May 2000. They had posttraumatic vertebral collapse or Kummell's disease and had failed medical therapy. Immediate and long-term pain response and complications of percutaneous vertebroplasty with bone cement were evaluated. RESULTS: All patients reported complete relief of pain within the first 24 hours. Ten(71.5%) were evaluated as excellent; three(21.4%), good; one(7.1%), fair until 3 months postoperatively. Eight(57.2%) were evaluated as excellent; four(28.6%), good; fair(7.1%), one; poor(7.1%), one at final follow-up. Five(35.7%) patients had cement extrusion into the disc, paravertebral vessels and epidural space without significant systemic symptoms. CONCLUSIONS: For patients with posttraumatic vertebral collapse or Kummell's disease, percutaneous vertebroplasty technique using bone cement would be a minimally invasive treatment option to achieve immediate relief of pain and stabilization without significant side effects.

Arthroscopic Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft: A Two-to Six-Years Follow-Up Evaluation / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical stability and function after an arthroscopic anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. MATERIALS AND METHODS: Fifty-nine patients could be evaluated and the mean follow-up period was 47 months (24-75 months). The evaluation included a detailed history, a physical examination, a KT-1000 arthrometer measurement, and the rating systems of Lysholm, IKDC and Shelbourne. RESULTS: Fifty-four patients (92%) had a negative pivot shift. Forty-five patients (77%) had a negative Lachman test. Forty-eight patients (82%) had less than a 3 mm difference of maximal manual difference by KT-1000 arthrometer. The prone heel height difference was less than 1 cm in 37 patients (63%). The mean Lysholm score was 89.5. Forty-five patients (76%) were normal or nearly normal for the measured parameters. Patello-femoral pain was not a significant problem for most of the patients who had a mean Shelbourne score of 88.5. CONCLUSION: Reconstruction of the ACL with a bone-patellar tendon-bone autograft resulted in a reliable and predictable outcome without having significant patello-femoral pain after 2 to 6 years'follow-up.

Reconstruction of Posterior Cruciate Ligament Using Bone-Patella Tendon-Bone Allograft - Two - to Four - Year Follow - Up Results

No Abstract Available.

External Fixation Of Lower Limb Fractures In Children / 대한정형외과학회잡지

PURPOSE: To evaluate the results and the usefulness of the external fixator for the treatment of the lower limb fractures in children. MATERIALS AND METHODS: We used 22 children fractures of lower limb treated with external fixator. There were 14 isolated femur or tibia fractures, 2 both femur and tibia fractures, 1 bilateral tibial fractures, 5 fractures associated with others, and were 10 open and 16 closed fracture. We assessed the axial alignment and leg-length discrepancy, and the range of motion of the joints and complications. RESULTS: The average union and fixation time were 8.1 and 9.5 weeks. Average of 2.4 degrees of varus or valgus and 3.8 degrees of anterior or posterior angulation were obtained. At follow-up, the range of LLD was -1.3 to +1.5cm. CONCLUSION: External fixator in lower limb fractures of children is useful to open fractures, multiple fractures, and unstable fractures to minimize complications.

Hybrid External Fixation in the Treatment of Periarticular Fractures of Tibia / 대한정형외과학회잡지

The authors constructed a simple hybrid frame by combining AO tubular and llizarov ring external fixator, using a modified AO single adjustable clamp. From 1997 Jan. to 1998 Apr. 19, periarticular fractures of the tibia were treated with hybrid external fixator. The clinical results using this frame were then analyzed. Of the 19 cases, there were 11 proximal and 8 distal periarticular fractures of the tibia. Open fractures were 5 cases in proximal and 2 cases in distal tibial fractures. All fractures were classified according to the AO classification. There were 1 A2, 4 A3, 1 C1, 5 C2 proximal and 1 A2, 4 A3, 1 C1, 2 C2 distal periarticular fractures. The mean bony union time was 13 wks (range 8-36 wks) and the mean length of time in the external fixator was 12 wks (range 8-36 wks). At last follow up, the MPTA of the proximal tibia was 87.2+/-0.8 and the LDTA of the distal tibia was 88.6+/-1.1. The mean articular depression of the intra-articular fractures was 1 mm. Complications were intermittent pin drainage in 7 patients (26.3%), deep infection in 1 patient (5.3%), delayed union in 3 patients (15.8%) and nonunion in 1 patient (5.3%). In conclusion, hybrid external fixation is a good treatment option for periarticular fractures of the tibia because of its simplicity, versatility, sufficient stability to allow early joint motion, little further soft tissue damage, and so on.

Arthroscopic Treatment of Meniscal Cysts

PURPOSE: To assess the efficacy of arthroscopic decompression of the meniscal cyst. MATERIAL AND METHOD: From January 1996 to December 1997, 8 patients with meniscal cyst were treated by arthroscopic cyst decompression as well as partial meniscectomy of torn menisci. The average follow-up was 18.8 months(range: 12~35 months). There were 6 men and 2 women and the average age was 38.1 years(range: 26 to 56 years). Six(75%) patients had no history of trauma associated with their symptoms. All the meniscal cysts were associated with horizontal tear of the menisci. The arthroscopic partial meniscectomy consisted of gentle trimming of leading edge of the superior leaf and excision out to peripheral rim of the inferior leaf, followed by intraarticular cyst decompression using probe, punch for-ceps or shaver with pressure over the cyst. Postoperative results were assessed according to the evaluation form of Glasgow et al. RESULT: The ratio of medial-to-lateral cyst formation was 1:1. Meniscal cysts were always associated with horizontal tears of the meniscus. The patterns of horizontal tear consisted of 2 horizontal/cleav-age(25%), 2 horizontal/flap(25%), and 4 horizontal/ degenerative complex tears(50%). The sites of meniscal tears were the posterior horn-midbody junction of the medial meniscus in 4, the anterior horn-midbody junction of the lateral meniscus in 3 and the midbody of the lateral meniscus in 1. We could get excellent or good results in all the patients with no recurrence of the cyst. CONCLUSIONS: The treatment of the meniscal cyst can be entirely arthroscopic(partial meniscectomy and intraarticular decompression of the cyst) with predictable success.

Horizontal Tear of the Meniscus / 대한정형외과학회잡지

Horizontal tear of the meniscus occurs most commonly in older patients. The tear begins initially with a simple horizontal cleavage which divides the meniscus into superior and inferior leaves resembling a fish mouth and which may become a flap or more complex tear with time if subjected to repeated injury. Thirty-four patients(36knees/40menisci) with horizontal tear of the meniscus, treated with arthroscopic partial meniscectomy except in 3 extensive tears at Ulsan University Hospital from Jan. 1993 to Jun. 1996, were analyzed to investigate the factors that may be associated with this type of meniscal tear, and the results were as follows; 1. The tears commonly occurred in labor workers(61.7%) and without obvious trauma history(67.6%), and the average age at the time of surgery was 44 years. 2. The most common site of the tear was posterior horn of the medial meniscus (62.5%). 3. The 40 horizontal tears consisted of 12 horizontaVcleavage(30%), 3 horizontaVflap(7.5%), and 25 horizontaUdegenerative complex tears(62.5%). 4. Degenerative changes were frequently noted in both arthroscopy(69.5%) and roentgenography (72.2%).

The Pathologic Anatomy of Degenerative Spondylolisthesis / 대한정형외과학회잡지

Degenerative spondylolisthesis, which occurs frequently in middle-aged women, is a disease that causes canal stenosis of the lumbar spine and low back pain. Although the clinical features have been described characteristically, its pathogenic mechanism and therapeutic principles are still to be clarified. Some investigators have claimed that the disease originates from morphologic abnormalities of laminae and facet joints or that it is primarily due to degeneration of the intervertebral disks and degenerative changes of the facet joints. We selected two groups of patients retrospectively. The one was a group of patient who had normal findings on their magnetic resonance imaging(Group I ) and the other was a group of patients who showed degenerative spondylolisthesis at L4-5 and had been managed surgically(Group II ). We measured the total lordosis from Ll to S 1 and segmental lordosis of L3-4, L4-5 and LS-S 1 in both groups by Cobbs method. In group 3, we measured the degree of slippage of the L4 vertebral body and investigated the associated congenital anomalies of the lumbosacral vertebra on simple anteroposterior and lateral radiographs in both groups. And we measured the facet joint angles of the L3-4, L4-5 and L5-Sl at both side on MRI. Then we analysed the results statistically and got the following conclusions. 1. In Group I, total lordosis decreased significantly. The segmental lordosis of L4-5 and LS-S1 decreased, too, but the segmental lordosis of L3-4 increased. 2. The facet joint angles of L4-5 in Group I increased significantly in both sides. 3. The intercrestal line was lower in Group I than in Group II. 4. The degree of slip was not related with the facet joint angles of L4-5.

Operative Treatment of the Bony Mallet Finger / 대한정형외과학회잡지

Although there are various methods of operative treatment for hony mallet finger, the operative technique is not so easy and complications such as joint stiffness, sott tissue prohlems, infection, change of nail shape and arthrosis are common. The authors performed operations for 26 cases of hony mallet fingers, fixing the hony frapment by Kirschner wire, pull-out wire suture and miniscrew respectively, from Jan. l988 to Jun. l996. The results were as follows. l. According to Niechajev's classification. there were 3 cases of type B, 7 cases of type C, l4 cases of type D, and 2 cases of type E. And 11 cases were accompanied hy crushing injury. 2. Involved fingers were third finger in 11cases, fit'th finger in 7 cases, fourth finger in 5 cases, second finger in 2 cases. and thumb in I case. 3. The hony mallet finger was caused hy occupational injury in l6 cases, direct blow in 7 cases and sports injury in 3 cases. 4. The fractured fragment was fixed hy Kirschner wire in 9 cases, by pull-out suture in 9 cases and by miniscrew in 8 cases. 5. The results were evaluated hy Kanies scale. Sixteen cases had satisfactory results. Seven cases (87.5%) were satisfactory in miniscrew fixations. 5 cascs (55.6%) in pull-out wire suture methocls and 2 cases (22.2%) in Kirschner wire tixations. 6. The complications were joint incongruity in 4 cases, dorsal prominece in 6 cases, painful limitation of motion in 2 cases which were treated by arthrodesis, pin site infection in 2 cases and hreakage of wire suture in 1 case. 7. The miniscrew fixation offered relatively firm fixation, low complication rate, and good results. so it can be considered as one of the good methods of treatment for hony mallet finger.

Treatment of the Distal Radius Fracture with Hinged External Fixator / 대한정형외과학회잡지

Pennig wrist fixator (Orthofix) is a dynamic external fixator which allows wrist motion in applied state in the treatment of distal radius fracture. The authors have treated unstable distal radius fracture with Orthofix external fixator and additional percutaneous K-wire fixation from January 1990 to June 1996. Among these cases, the authors analysed the clinical result of 40 cases which were available for follow-up for more than one year. The analysis was performed on the basis of the change of radiographic findings and modified Gartland & Werley criteria. The results were as follows; 1. According to Frykmann classification, 3 cases were Type I; 1 case, Type II; 4 cases, Type III; 2 cases, Type IV; 4 cases, Type V; 5 cases, Type VI; 20 cases, Type VII; 1 case, Type VIII. 2. We could get the improved values after operation as radial inclination 22.6degrees, radial length 10.7mm and volar tilt 8.8degrees. 3. There were little differences in value between at the immediate postoperative roentgenogram and at the last follow up one; radial inlclination decreased 1.2degrees, radial length shortened 2.5mm, volar tilt decreased 2.3degrees. 4. In 3 cases, the level of the ball joint of the fixator was not adjusted appropriately, so the initial satisfactory reduction was disrupted. 5. According to modified Gartland & Werley criteria, 34 cases (85%) were excellent and good. Pennig dynamic wrist fixator (Orthofix) allows the wrist motion earlier than the static external fixator without disturbing the initial reduction state, so it could be suggested as one of the good fixation devices for the treatment of the unstable distal radius fracture.