Hybrid external fixation for neglected fractures of the distal radius: results after one year

Abstract

Background: External fixation is a well-established procedure for the treatment of unstable fractures of the distal radius, but its use is beset with complications. A plethora of theoretical and experimental data suggests that nonbridging fixators are superior for this setting. A new concept for the use of hybrid external fixation seemed reasonable and was applied for this study.

Materials and methods: We report on the first 14 cases of unstable, extraarticular fractures of the distal radius with a one-year follow-up and describe the operative technique. All were treated at 3-5 weeks after injury; nevertheless, closed reduction after the fixator elements were fixed to the bone was always possible.

Results: We had no intraoperative complications, but in the follow-up period three cases of algodystrophy and one transient irritation of the ulnar nerve ensued. One case developed superficial infection at the K-wire entry site that resolved with local care and systemic antibiotics. No redisplacements were observed. Early and late (at one year) evaluation of results revealed good and very good anatomic results (Lidström system) and two satisfactory (cases with algodystrophy), eight very good and four good functional outcomes (Gartland-Werley system). The patients' acceptance of the device was high.

Conclusions: Hybrid external fixation of neglected distal radial fractures results in good outcomes if care is taken to prevent overdistraction of bone fragments.

Fig. 1

Hybrid external fixation of a distal radial fracture

Fig. 2

Safe zones for K-wire placement in the ultradistal forearm; black muscles; red arteries; blue veins; gray nerves

Fig. 3

Overdistraction of bone ends

Fig. 4

Ilizarov 3/5 steel ring mounted on the distal bone fragment with extensions for good lateral radiographic visualization of the radiocarpal articular slope

Fig. 5

Severe algodystrophy manifested on an X-ray