Summary
Goal of Surgery
Anatomical reduction and immediate stability of unstable, intraarticular distal radius fractures using an external fixator.
Surgical Technique
Insertion of half pins into radius and base of second metacarpus.
Application of external fixator and reduction.
Harvesting of autogenous bone grafts from the iliac crest and insertion into fracture gap through a dorsal approach.
Indications
Comminuted distal radius fractures with or without articular involvement.
Contraindications
A volar Barton fracture is a relative contraindication.
Positioning and Anaesthesia
Supine.
Free draping on a radiolucent hand table.
Prepping of opposite iliac crest.
Postoperative Management
Early exercises of fingers and elbow.
Removal of external fixator after 3 weeks and application of short arm brace for 3 weeks.
Active physiotherapy thereafter.
Possible Complications
Injury to superficial sensory branch of radial nerve.
Adhesions around extensor indicis proprius.
Fracture of second metacarpus.
Results
Between 1989 and 1991 98 comminuted distal radius fractures were treated, 95 of which were intraarticular.
Average time of follow-up 27 months (15 to 38 months).
Using Gartland and Werley scoring system 87.7 of patients had good and excellent, 10.2 satisfactory and 2.1 poor results.
All but three had normal radiocarpal and volar tilt angles. Marked joint space narrowing was seen in 2 patients.
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References
Frykman, G.: Fracture of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function: a clinical and experimental study. Acta orthop. scand., Suppl. 108 (1967).
Gartland, J. J., C. W. Werley: Evaluation of healed Colles' fractures. J. Bone Jt Surg. 33-A (1951), 895–907.
Knirk, J. L., J. B. Jupiter: Intraarticular fractures of the distal end of the radius in young adults. J. Bone Jt Surg. 68-A (1986), 647–659.
Leung, K. S., W. Y. Shen, A. W. G. Kinninmonth, P. C. Leung, J. C. W. Chang, G. P. Y. Chan: Ligamentotaxis and bone grafting for comminuted fractures of the distal radius. J. Bone Jt Surg. 71-B (1989), 838–842.
Leung, K. S., W. S. So, V. D. F. Chiu, P. C. Leung: Ligamentotaxis for comminuted distal radial fractures modified by primary cancellous grafting and function nal bracing: long-term results. J. Orthop. Trauma 5 (1991), 265–271.
Schuind, F., M. Donkerwolcke, F. Burny: External fixation of wrist fractures. Orthopaedics 7 (1984), 841–844.
Seitz, W. H., A. I. Frominson, D. B. Brooks, P. D. Postak, R. D. Parker, J. M. LaPorte, A. S. Greenwald: Biomechanical analysis of pin placement and pin size for external fixation of distal radius fractures. Clin. Orthop. 251 (1990), 207–212.
Vidal, J., C. Buscayret, M. Paran, J. Melka: Ligamentotaxis. In: Mears, D. C. (ed.): External skeletal fixation. Williams & Wilkins, Baltimore 1983, p. 493–496.
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Leung, Ks. Ligamentotaxis and bone graft for comminuted distal radial fractures. Operat Orthop Traumatol 8, 96–104 (1996). https://doi.org/10.1007/BF02512772
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DOI: https://doi.org/10.1007/BF02512772