The treatment of comminuted distal radius fractures caused by high-energy injuries / 中华骨科杂志

ABSTRACT

Objective To analyze retrospectively the results of closed reduction and static transarticular fixation with unilateral external fixators in the treatment of severely comminuted distal radius fractures caused by high-energy injuries. Methods From June 2000 to June 2003, 20 patients with 24 severely comminuted distal radius fractures were treated with closed reduction and static transarticular fixation with unilateral external fixator. The injuries involved 16 males and 4 females, the age of the patients was from 15 to 48 years (average 33.4 years). All fractures were classified as Frykman's type Ⅷ or AO type C3. The operative technique consisted of reduction of the fractures by manipulation or assisted with the external fixator, then fixed them statically. The mean duration of the union was 7.4 weeks (ranged from 6-8 weeks). After the fixator removal, the patients were encouraged to proceed for the rehabilitations, such as the elbow flexion-extension, radial abduction, ulnar adduction, and the pronation as well as the supination of the forearm. Results All patients were available at the final follow-up, the mean duration was 16 months (range, 6-42 months). At the last examination, the radiological manifestations revealed excellent in 21 fractures (17 patients) and good in 3 (3 patients) according to the Sarmiento scoring system (modified by Stewart); and the functional results displaied excellent in 16 (13 patients), good in 6 (5 patients) and fair in 2 (2 patients) according to Gartland-Werley functional assessment system. There were only 2 cases of superficial pin site infection cured with oral antibiotics and local care with mild disinfectants. 7 obvious defect of mataphysis occurred in 5 patients, but the fractures united simultaneously without any additional treatment. And there was no any complication, such as pin tract infection, fixator loosening, iatrogenic fracture and injury of the superficial radial nerve. Conclusion The technique of closed reduction by manipulations or external fixators combined with static transarticular fixation plus unilateral external fixators is an effective method for the treatment of severely comminuted distal radius fracture caused by high-energy injuries, such as falling from the height. It is unnecessary to apply supplementary bone grafts to promote bone healing. The complications can be avoided by selecting the right sites for the insertion of the pins, which is beneficial for the hand to mobilize earlier after operation.