Abstract
When closed manipulation fails to restore articular congruity in comminuted, displaced fractures of the distal radius, open reduction and internal fixation is required. Results of surgical stabilization and articular reconstruction of these injuries are reviewed in this retrospective study of 49 patients with 52 displaced, intra-articular distal radius fractures. Forty-three patients (87%) with a mean age of 37 years (range of 17 to 79 years) were available for evaluation. The mean follow-up time was 38 months (range 22-69 months). When rated according to the Association for the Study of Internal Fixation (ASIF), 19 were type C2 and 21 were type C3. We devised an Injury Score System based on the initial injury radiographs to classify severely comminuted intra-articular fractures and to identify those associated with carpal injury (3 patients). Post-operative fracture alignment, articular congruity, and radial length were significantly improved following surgery (p < .01). Grip strength averaged 69% +/- 22% of the contralateral side, and the range of motion averaged 75% +/- 18% of the contralateral side post-operatively. A combined outcome rating system that included grip strength, range of motion, and pain relief averaged 76% +/- 19% of the contralateral side. There was a statistically significant decrease in the combined rating with more severe fracture patterns as defined by the ASIF system (p < .01), Malone classification (p < .03), and the Injury Score System (p < .001). The Injury Score System presented here, and in particular the number of fracture fragments, correlated most closely with outcome of all the classification systems studied. Operative treatment of these distal radius fractures with reconstruction of the articular congruity and correction of the articular surface alignment with internal fixation and/or external fixation, can significantly improve the radiographic alignment and functional outcome. Furthermore, the degree to which articular stepoff, gap between fragments, and radial shortening are improved by surgery is strongly correlated with improved outcome, even when the results are corrected for severity of initial injury, whereas correction of radial tilt or dorsal tilt did not correlate with improved outcome.
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- Axelrod T. S., McMurtry R. Y. Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius. J Hand Surg Am. 1990 Jan;15(1):1–11. doi: 10.1016/s0363-5023(09)91097-8. [DOI] [PubMed] [Google Scholar]
- Cooney W. P., 3rd, Linscheid R. L., Dobyns J. H. External pin fixation for unstable Colles' fractures. J Bone Joint Surg Am. 1979 Sep;61(6A):840–845. [PubMed] [Google Scholar]
- Edwards G. S., Jr Intra-articular fractures of the distal part of the radius treated with the small AO external fixator. J Bone Joint Surg Am. 1991 Sep;73(8):1241–1250. [PubMed] [Google Scholar]
- GARTLAND J. J., Jr, WERLEY C. W. Evaluation of healed Colles' fractures. J Bone Joint Surg Am. 1951 Oct;33-A(4):895–907. [PubMed] [Google Scholar]
- Gainor B. J., Groh G. I. Early clinical experience with Orthofix external fixation of complex distal radius fractures. Orthopedics. 1990 Mar;13(3):329–333. doi: 10.3928/0147-7447-19900301-12. [DOI] [PubMed] [Google Scholar]
- Green D. P., O'Brien E. T. Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg Am. 1978 May;3(3):250–265. doi: 10.1016/s0363-5023(78)80089-6. [DOI] [PubMed] [Google Scholar]
- Green D. P. Pins and plaster treatment of comminuted fractures of the distal end of the radius. J Bone Joint Surg Am. 1975 Apr;57(3):304–310. [PubMed] [Google Scholar]
- Horesh Z., Volpin G., Hoerer D., Stein H. The surgical treatment of severe comminuted intraarticular fractures of the distal radius with the small AO external fixation device. A prospective three-and-one-half-year follow-up study. Clin Orthop Relat Res. 1991 Feb;(263):147–153. [PubMed] [Google Scholar]
- Howard P. W., Stewart H. D., Hind R. E., Burke F. D. External fixation or plaster for severely displaced comminuted Colles' fractures? A prospective study of anatomical and functional results. J Bone Joint Surg Br. 1989 Jan;71(1):68–73. doi: 10.1302/0301-620X.71B1.2915010. [DOI] [PubMed] [Google Scholar]
- Jenkins N. H. The unstable Colles' fracture. J Hand Surg Br. 1989 May;14(2):149–154. doi: 10.1016/0266-7681_89_90116-2. [DOI] [PubMed] [Google Scholar]
- Jupiter J. B. Fractures of the distal end of the radius. J Bone Joint Surg Am. 1991 Mar;73(3):461–469. [PubMed] [Google Scholar]
- Knirk J. L., Jupiter J. B. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986 Jun;68(5):647–659. [PubMed] [Google Scholar]
- Leung K. S., Shen W. Y., Tsang H. K., Chiu K. H., Leung P. C., Hung L. K. An effective treatment of comminuted fractures of the distal radius. J Hand Surg Am. 1990 Jan;15(1):11–17. doi: 10.1016/s0363-5023(09)91098-x. [DOI] [PubMed] [Google Scholar]
- Pogue D. J., Viegas S. F., Patterson R. M., Peterson P. D., Jenkins D. K., Sweo T. D., Hokanson J. A. Effects of distal radius fracture malunion on wrist joint mechanics. J Hand Surg Am. 1990 Sep;15(5):721–727. doi: 10.1016/0363-5023(90)90143-f. [DOI] [PubMed] [Google Scholar]
- Sarmiento A., Pratt G. W., Berry N. C., Sinclair W. F. Colles' fractures. Functional bracing in supination. J Bone Joint Surg Am. 1975 Apr;57(3):311–317. [PubMed] [Google Scholar]
- Seitz W. H., Jr, Froimson A. I., Leb R., Shapiro J. D. Augmented external fixation of unstable distal radius fractures. J Hand Surg Am. 1991 Nov;16(6):1010–1016. doi: 10.1016/s0363-5023(10)80060-7. [DOI] [PubMed] [Google Scholar]
- Szabo R. M., Weber S. C. Comminuted intraarticular fractures of the distal radius. Clin Orthop Relat Res. 1988 May;(230):39–48. [PubMed] [Google Scholar]