title: Intra-articular fractures of the distal end of the radius treated with an adjustable fixator system.
abstract: Twenty-five wrists with comminuted, displaced, intra-articular fractures of the distal radius were prospectively treated with an adjustable external fixator for an average of 51 days. Twenty fractures (80% [20 of 25] were available for follow-up) in 16 adults (mean age, 34 years) were treated with the Wrist Jack external fixator system (Hand Biomechanics Lab, Sacramento, CA) and evaluated at a mean follow-up period of 25 months. Ten patients (12 fractures) sustained high-energy trauma with multiple injuries, while 6 patients (8 fractures) sustained isolated distal radius fractures. Percutaneous pins supplemented the fixation in 6 fractures. All fractures were reduced to restore articular congruity to within 1 mm. At follow-up, 5% were excellent, 75% good, 20% fair, and none as poor using the demerit point system of Gartland and Werley as modified by Sarmiento. Grip strength averaged 80% of the unaffected limb. Seventeen of the 20 fractures showed some evidence of articular incongruity at follow-up evaluation. Restoration of palmar tilt, radial inclination, radial length, and range of motion were at acceptable values. Subjective analysis confirmed 85% of the patients to have only occasional pain or none at all and 15% to have some pain with weakness or limitation of motion. Two patients required additional surgery: 1 underwent a Darrach procedure and the other a tendon transfer for a rupture of the extensor pollicis longus tendon. Results suggest that an external fixator system provides an additional alternative to the surgical armamentarium for an otherwise difficult fracture fixation problem.
authors.affiliation: Section of Orthopaedic Surgery, University of Michigan Hospitals, Ann Arbor 48109-0328, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Zanotti
authors.forename: D S
authors.initials: DS
authors.lastname: Louis
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D003100:Colles' Fracture / Q000000981:diagnostic imaging / Q000628:therapy*; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000628:therapy*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome