Treatment of Distal Radius Fractures Using the Percutaneous K-wire Reduction-Fixation and External Fixator

PURPOSE: To analyse the results of treatment of unstable intra-articular distal radius fractures using the percutaneous K-wire reduction-fixation and external fixator. MATERIALS AND METHODS: A retrospective follow-up study of 22 cases was carried out. With use of the system of AO classification 9 cases were in C1 and 7 in C2, and 6 in C3. The average duration of follow-up for all fractures was 35 months. We evaluated the radiologic results, the functional results according to clinical evaluation scoring system by Green and O'Brien and osteoarthritis grade according to arthritic grading system by Knirk and Jupiter. RESULTS: Excellent and good results were rated in 17 cases (77%) of all cases. At last follow-up the mean loss of radial length, radial inclination and volar tilt were 1.4 mm, 1.0o, and 1.4o respectively. Also 7 patients had grade I, 1 patient grade II, and 1 patient grade III arthritis. CONCLUSION: We think that percutaneous K-wire reduction-fixation and external fixation is useful treatment method for the unstable intra-articular distal radius fracture. But severely comminuted AO type C3 fractures would need additional treatments such as open reduction and bone graft to acquire and maintain the articular reduction for better results.

Treatment of Unstable Intra-articular Fracture of Distal Radius: Comparison of Closed Reduction and External Fixation versus Open Reduction and Internal Fixation / 대한정형외과학회잡지

PURPOSE: To compare the functional and radiographic results of the treatment in unstable intra-articular fractures of distal radius by closed reduction and external fixation versus open reduction and internal fixation. MATERIALS AND METHODS: Forty cases of unstable intra-articular fractures of distal radius were treated either by application of closed reduction and external fixation (CREF) or by open reduction and internal fixation (ORIF) between March 1989 and June 1997. They were followed up for more than one year. To assess the functional results, we used Green and O' Brien' s score system and for the radiographic results, measured volar tilt, radial inclination and radial length. RESULT: In functional results, excellent to good results were obtained in 19 cases (76%) in the CREF group and 10 cases (80%) in the ORIF group, and the average score was 81.4 and 82.8 by the Green and O' Brien' s score system. In radiographic results, mean loss of volar tilt, radial inclination and radial length were 1.4 degree (13.4%), 2.0 degree (9.0%), 1.3 mm (10.3%) in the CREF group and 1.2 degree (10.8%), 1.6 degree (6.1%) and 1.2 mm (11.5%) in the ORIF group on last follow-up radiographs. There was no evidence of statistical difference between two groups in functional and radiographic results (P>0.05). CONCLUSIONS: If an appropriate operative method is selected according to the presence of several properties, including the pattern of fracture, the general condition and activity of patient and the degree of soft tissue injury, the two operative managements are considered useful to restoring articular congruity and alignment and to allow early postoperative range of motion exercise

Surgical Treatment for Unstable Intra-articular Fracture of Distal Radius / 대한정형외과학회잡지

Authors reviewed 21 cases of unstable intra-articular fractures of the distal radius treated with open reduction and internal fixation to improve anatomical and functional results during March 1990 to May 1993 at Dong-A University Hospital. The following results were obtained; 1. The most common injury type was type VIII(9 cases) according to Frykman's classification, type C,(8 cases) according to AO classification, and open fractures were 4 cases. 2. Twelve cases were treated with open reduction and internal fixation with external fixator and 9 cases were treated with open reduction and internal fixation with cast. 3. According to demerit point rating system, excellent to good results were obtaned in 76.2%. In cases of external fixator application, excellent and good results were 88.3%, compared to 66.7% in cases of cast application. 4. In last follow-up examination, the mean loss of radial length was 0.9mm(10.0%) in cases of cast, but 0.3mm(3.3%) in cases of external fixator, the mean loss of radial inclination was 2.7° (16.7%) and 1.8° (11.0%) respectively, the mean loss of volar tilt was 2.9° (19.6%) and 2.4° (16.4%) respectively, and there were statistical significances in all three parameters between the external fixator group and the cast group(p < 0.05). 5. Open reduction and internal fixation, combined with external fixation was thought to be a better method than open reduction and internal fixation with cast for the treatment of unstable comminuted fractures of the distal radius, because that was more comfortable and convenient to patients and useful to prevent late displacement or collapse of fractures.