Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern?

Abstract

The aim of this retrospective study was to evaluate the medium-term clinical and functional outcomes of patients with closed, displaced, and unstable, simple or complex, intra- and extra-articular distal radius fractures (DRFs) treated with a bridging external fixator (BEF) and optional K-wires (KWs). AO classification was used to differentiate the injuries radiographically. Clinical-functional outcomes were evaluated using the Patient-Rated Wrist and Hand Evaluation Score (PRWHE Score) and the Quick Disabilities of the Arm Shoulder and Hand Score (QuickDASH). A total of 269 dorsally displaced fractures of 202 female (75%) and 67 male subjects (25%) were included, with a mean follow-up of 58.0 months. Seventy-five patients (28%) were treated by additional KWs. No differences were found comparing the two groups of patients (BEF vs. BEF + KWs) regarding age, sex, and fracture side (dominant vs. non-dominant). PRWHE and QuickDASH scores were lower in the BEF + KWs group compared to the BEF group (p < 0.0001 and p = 0.0007, respectively). Thus, patients treated with KWs had a better clinical outcome. Beta multivariate regression analysis confirmed that patients of the BEF + KWs group exhibited a better PRWHE score but not a better QuickDASH score. Patients treated by the BEF + KWs with the fracture on the dominant site were characterised by better clinical outcomes. Older patients had a better PRWHE score independently from the treatment. Our findings suggest that the use of BEF for DRFs with optional KWs can be indicated in both young and elderly patients of any gender, independent of limb side and fracture pattern. As the best functional results were achieved in the elderly when KWs were added, the combination of BEF and KWs seems to be mainly indicated for the treatment of DRF, also complex, in the elderly population.

Keywords: K-wires; PRWHE score; QuickDASH; bridging external fixator; distal radius fracture; external fixator; wrist injury.

Figure 1

The complete kit of the Bridging External Fixator (BEF) for the wrist by Citieffe.

Figure 2

Intra-operative images showing: (a) dorsal skin incision at the base of the second metacarpal bone; (b–d) insertion of the first distal bicortical pin; (e) insertion of the second distal cortical pin using the proper tool to maintain the right distance between the pins; antero-posterior (AP) fluoroscopic control of (f) the first and (g) the second distal pin on the second metacarpal bone.

Figure 3

Intra-operative images showing: (a) insertion of the pins in the radial diaphysis between the middle third and the distal third of the forearm; (b) all pins positioned correctly; (c) final application of BEF; (d) antero-posterior (AP) and (e) latero-lateral (LL) fluoroscopic views of the proximal pins; (f) insertion of the KW at the radial styloid level. Post-operative radiographic images: (g) AP and (h) LL views showing proper reduction and stabilisation of the DRF (AO: 23-C2).

Figure 4

A 69-year-old female patient treated with BEF for an AO 23-B3 DRF. Antero-posterior (AP) and latero-lateral (LL) radiographic images at (a,b) pre-operative period; (c,d) immediate post-operative period; (e,f) at 2-month follow-up. Clinical-functional images showing: (g) extension, (h) flexion, (i) pronation, and (l) supination of the operated wrist at last follow-up.

Figure 5

A 58-year-old female patient treated with BEF and an additional KW for an AO 23-C2 DRF. Antero-posterior (AP) and (b) latero-lateral (LL) radiographic images at (a,b) pre-operative period; (c,d) immediate post-operative period; (e,f) at 2-month follow-up. Clinical-functional images showing: (g) extension, (h) flexion, (i) pronation, and (l) supination of the operated wrist at last follow-up.

Figure 6

Flowchart of patient selection.