Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation

doi:10.1016/S0020-1383(99)00207-7

Injury

Volume 31, Issue 2, March 2000, Pages 75-79

https://doi.org/10.1016/S0020-1383(99)00207-7 Get rights and content

Abstract

Fractures of the distal end of the radius are common injuries and are the commonest bony injury around the wrist. Management of these fractures has remained controversial as far as modality of treatment is concerned. In this study 90 adult cases of acute displaced intra-articular fractures of the lower end of the radius were classified according to Frykman's and AO classifications after obtaining radiographs in antero-posterior and lateral planes. These were randomly treated by one of three methods: (1) closed reduction and plaster immobilisation, (2) external fixation and (3) open reduction and internal fixation, and were followed for an average of 4 yr. In the final functional assessment (Sarmiento) the results were (1) plaster 43% good and excellent, 50% fair and 7% poor, (2) external fixator 80% good and excellent, 20% fair and poor results, (3) open reduction and internal fixation 63% good and excellent, 26% fair, 11% poor. We recommend that displaced severely comminuted intra-articular fractures should be treated with an external fixator.

Introduction

Fractures of the distal end of the radius have often been considered primarily extra articular injuries of elderly female. The distal end of the radius is being exposed to increasingly severe trauma in younger patients. The carpus is drawn into the distal end of the radius like a diepunch resulting in comminution of its articular surface. The reports of treatment methods and results are conflicting. Treatment of such injuries is often difficult and demanding, particularly when the fracture is severely comminuted or displaced. Varying patterns of intra-articular fractures are common in adults. They are commonly referred to as Colle's Barton's or Smith's, depending upon the pattern of involvement of the distal radio ulnar and radio carpal joint surface and the displacement. Nonoperative management often includes the acceptance of some degree of displacement and emphasis is placed on function [1]. Cooney et al. [2] had stressed the importance of anatomical correction and chose various methods of external fixation to achieve it. Bradway et al. [3] had laid emphasis on achieving and maintaining an anatomical reduction of fracture fragments by open reduction and internal fixation. The study was undertaken to evaluate the results of various modalities of treatment in displaced intra-articular fractures of the distal radius.

Section snippets

Materials and methods

The study has been carried out in the department of orthopaedic surgery, Maulana Azad Medical College and associated LNJP and G.B. Pant Hospitals between July 1991 and July 1996.

Ninety adults cases of acute displaced intra-articular fractures of the lower end of the radius were included in the study and were followed up for an average of 4 yr. Assessment of the fracture was based on Frykman's and AO classifications [7] after obtaining anteroposterior and lateral radiographs. The patients were

Frykman's classification

The three groups were also similar in the fracture distribution according to Frykman's classification. Frykman's type VII and type VIII formed 67% of the study.

The dominant side was involved in 65% of cases. The three groups were followed up for an average of 4 yr. On comparing loss of dorsiflexion and palmarflexion we found the least loss with the fixator following by open reduction and internal fixation and then plaster (Fig. 3).

Discussion

The three groups were similar in age, sex and deformity. The average age was 39 yr. In other reported series the average age was 63 [2], 27.6 [4] and 37 [5].

The mode of injury was road traffic accident in seventy percent of cases. This is similar to the findings of Jupiter and Knick [4].

The average loss of the arc with plaster was 37° in comparison with 19° by external fixator. Cooney et al. [2] reported an average loss of 17° by external fixator with loss of 10° if pronation and supination and

Conclusion

We conclude that primary operative treatment generates significantly better anatomical and functional results than closed reduction and casting. Plaster case is insufficient to maintain the reduction in the majority of displaced intra-articular fractures. Remanipulation is required in a large percentage of cases, reduction slips often, cosmetic deformity persists and there are a large number or associated complications.

Open reduction and internal fixation provides the best articular anatomy and

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Distal radius fractures are the most frequent upper limb injuries encountered by orthopedic surgeons. Surgical treatment of distal radius fractures is preserved for unstable and displaced fractures. A randomized controlled trial was conducted to compare the radiological and functional outcomes of bridge plating (BP) to external fixation (EF) in comminuted intra-articular distal radius fractures.
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