title: Pilon fractures of the wrist. Displaced intra-articular fractures of the distal radius.
abstract: 22 patients who sustained high energy wrist injuries are reported. These complex injuries resulted in articular disruption of the distal radius. Associated injuries included scapho-lunate dissociation (18%), central die-punch injuries (14%), ulnar fractures (41%) and diastasis at the distal radioulnar joint (23%). Nine fractures (41%) were open and almost a third of patients had other skeletal injuries. All patients were treated by external fixation and reviewed after a mean follow-up of 2 1/2 years. There were no excellent results and only ten good ones (45%). The mean functional impairment was 32%. The external fixator was effective in maintaining extra-articular alignment, but not in ensuring accurate reduction of the articular surface. Residual incongruity of the joint surface was an adverse prognostic feature. All five patients (22%) with an articular step of more than 2 mm. developed symptomatic arthritis. Failure to restore the joint line did not account for all the unsatisfactory results; persistent scapho-lunate dissociation and problems at the distal radioulnar joint were also important.
authors.affiliation: Park Hospital, Davyhulme.
authors.forename: M L
authors.initials: ML
authors.lastname: Porter
authors.forename: R M
authors.initials: RM
authors.lastname: Tillman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005592:Fracture Fixation; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000601:surgery*; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*