title: External fixation for unstable intra-articular distal radial fractures in women older than 55 years. Acceptable functional end results in the majority of the patients despite significant secondary displacement.
abstract: Unstable intra-articular distal radial fractures in women older than 55 years were treated by closed reduction and external fixation to achieve the best functional outcome. Sixteen women had radiographic and functional assessment. Despite initial good alignment secondary displacement occurred in 11 patients, probably due to the comminution of the fracture and possibly influenced by osteoporosis. Malunion of the distal radius was seen in two patients and intra-articular incongruity with an intra-articular step exceeding 1 mm was observed in two other patients. The functional outcome was excellent or good in 10 and fair in two patients. Four patients had a poor functional outcome. Two of these patients had a significant loss of reduction, one resulting in a malunion. The other two had an intra-articular incongruity of more than 1 mm. Three of the four patients with a poor functional outcome had clinical signs of reflex sympathetic dystrophy.
  
  
  CONCLUSIONS
  Closed reduction and external fixation of "bad case" severely comminuted unstable distal radial fractures in the elderly may result in an acceptable functional outcome in the majority of the cases, although significant secondary displacement occurred in eleven of the sixteen patients.
authors.affiliation: Department of Surgery, Medisch Spectrum Twente Enschede and the Department of Traumatology, University Hospital Groningen, Oscar Wildestraat 49, 9746 AR Groningen, The Netherlands. hegeman.eijkelkamp@wxs.nl
authors.forename: J H
authors.initials: JH
authors.lastname: Hegeman
authors.forename: J
authors.initials: J
authors.lastname: Oskam
authors.forename: P A M
authors.initials: PA
authors.lastname: Vierhout
authors.forename: H J
authors.initials: HJ
authors.lastname: Ten Duis
mesh_terms: D000058:Accidental Falls; D000368:Aged; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D017759:Fractures, Malunited / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology