Osteosynthesis in Distal Radius Fractures with Conventional Bridging External Fixator; Tips and Tricks for Getting Them Right

Abstract

Background: Distal radius fractures are the commonest fractures occurring in the upper extremity, accounting for 15-20% of patients treated in emergency department. Although distal radial fractures were described 200 years ago, they still remain as unsolved fractures with no clear guidelines. It is often reported that anatomical reduction has a bearing on the functional outcome.

Aim: To study the management of distal end radius fracture by utilizing the principle of ligamentotaxis where in the reduction obtained by closed means is maintained by external fixator till solid bony union occurs.

Materials and methods: A total of 26 cases were selected for study by scrutiny of the inclusion and exclusion criteria. Most of our cases were treated with external fixator within 8 hrs of injury. Small A.O external fixator (bridging ex-fix) with 2 pins each in radius and 2(nd) metacarpal percutaneously was used for all the cases. Selective k wire fixation was done in cases of instability. Fixator was removed after 6 weeks. Guided physiotherapy was ensured in all the cases. Patients were followed up for an average of 9 months.

Results: Modified Gartland and Werley scoring system was used to evaluate the overall functional results. Excellent to good results were achieved in 88.45% of our cases while fair result was in 11.54 %. One case had pin loosening and two other cases had malunion.

Conclusion: External fixator used for ligamentotaxis is an effective method of treating unstable extraarticular and complex intraarticular fractures of distal radius. Improved anatomical restoration with early rehabilitation has produced favourable functional outcome in our series. The complications like pin tract infection is rare due to the availability of superior antibiotics and sterile surgical technique. complications like wrist and finger stiffness has improved with physiotherapy.

Keywords: Finger stiffness; Ligamentotaxis; Percutaneous pinning.

[Table/Fig-3]:

Sequential intra-op clinical photographs showing the procedure of application of bridging external fixator.

[Table/Fig-4]:

(a) Pre-op radiograph showing distal radial fracture; (b) Post –op radiograph showing insitu K wires with external fixator; (c,d) 3 months Post–op clinical photograph showing unrestricted range of motion of left wrist.

[Table/Fig-5]:

Sequential Pre-op, Intra-op and Post-op pictures of 2 patients: (a,b) showing comminuted distal radial fracture treated by bridging external fixator with acceptable reduction.