Functional outcome of external fixators in unstable distal radius fractures

Abstract

Background: Fractures of distal radius are very common injuries, accounting for about 15% workload of an Orthopedic trauma unit. While cast treatment is universal for stable fractures, unstable fractures with comminution and intrarticular involvement are a different injury and are treated mainly by ligamentotaxis with proper restoration of anatomy. In this study, we evaluated the effectiveness of external fixator with or without augmentation for management of unstable distal radius fractures. Methods: The study was performed on 49 patients with unstable distal radius fractures admitted in the emergency department. Patients who met inclusion criteria, were operated with bridging external fixation using 2 pins in radius and 2 pins in second metacarpal augmented with percutaneous K wires in some patients. Functional evaluation at 12 months was done using Solgaard Scoring. Results: The study comprised of 49 patients in age group of 20-60 years, including 28 males and 21 females with a mean age of 42 years. Laterality included right side (n=23) and left (n=26). Mechanism of injury was road traffic accident (n=19), fall from height (n=17) and fall from standing height (n=13). The mean admission to surgery interval was 1.2 days, the mean operative time was 35 minutes and the mean time to union was 7.2 weeks. Complications included pin tract infections (n=7), transient neuropathies (n=5), early sympathetic dystrophy (n=2), malunion (n=2) and loss of motion more than 200 (n=9). Final evaluation done using Solgaard scoring system revealed excellent results in 22 patients, Good in 18 patients, Fair in 8 patients and Poor in one patient. Conclusion: For unstable distal radius fractures excluding shear injuries, external fixation with or without augmentation is the preferred method of treatment as it is simple, less expensive, with acceptable complications and yields excellent results in a majority of patients.