[Combined palmar and dorsal approach for complex distal radius fractures].
OBJECTIVE
The purpose of this paper was to describe our management of complex fractures of the distal radius using a combined dorsal and palmar approach and to evaluate the radiological and clinical outcome.


METHODS
Twenty out of 26 patients with complex fractures of the distal radius, which were operated on from 1996 to 2000 using a combined dorsal and palmar approach, were followed-up on an average of 28 months. According to AO fracture classification, there were one A3, two B3, three C1, two C2 and twelve C3 fractures. Six patients had associated injuries. The treatment was standardized: closed reduction on the day of injury; depending on the soft-tissue situation an external fixator or a forearm splint was applied; every patient underwent a computed tomography before the definitive surgical procedure, which was performed between one and 28 days after the injury when the swelling had subsided. According to the fracture patterns, the distal radius was stabilized using double plates (3), a palmar plate (11) or a dorsal plate (4), screws (1) or K-wires (1) combined with the initially applied external fixator (6). Follow-up included a radiological and clinical examination. The results were graded with use of the modified Mayo Wrist Score. Disability was assessed using the DASH score.


RESULTS
All fractures healed, some with minor malunion. Fourteen of the 20 patients had osteoarthrotic changes. Compared to the opposite wrist, range of motion for flexion/extension was reduced by 25 %, radial/ulnar deviation by 20 % and forearm rotation by 5 %. Grip strength averaged 15 % less than that of the opposite side. Modified Mayo Wrist Score revealed 65 % excellent, 30 % good and 5 % poor results. DASH score averaged 18 points.
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Abteilung Orthopädie-Unfallchirurgie-Sanitätsbetrieb Bozen, Bolzano, Italy. d.espen@libero.it
D000328:Adult; D000368:Aged; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D018460:Fractures, Comminuted / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006225:Hand / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D010003:Osteoarthritis / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011885:Radius Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D014057:Tomography, X-Ray Computed; D014953:Wrist / Q000000981:diagnostic imaging / Q000601:surgery; D014954:Wrist Injuries / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*