[Complex fragmentation of the distal radial articular surface. Reconstruction with subchondral Kirschner wires and bone grafts].
BACKGROUND
Complex fragmentation of the distal radial articular surface often results in three major problems: some fragments are too small for stabilisation by standard plates or screws; in addition, substantial loss of articular surfaces and metaphyseal/subchondral bony defects frequently occur.


METHODS
To solve these problems the following strategy was developed: the fixation of small articular fragments was performed by small K-wires that were placed subchondrally and countersunk in the bone. In case of lost articular surfaces a silicone foil was inserted intra-articularly to induce a cartilage-like tissue. Bony defects were replaced by iliac crest bone grafts. Additional stability was achieved by dorsal and volar plate fixation or bridge plating.


RESULTS
An average of 53° of extension, 44° of flexion, 74° of pronation, and 66° of supination were achieved. The grip strength was an average of 61% of that in the contralateral limb. The average radiographic measurements were -5° of palmar inclination, 21° of ulnar inclination, and 0 mm of positive ulnar variance. A good or excellent functional result was achieved for five of seven wrists according to the rating system of Gartland and Werley. According to the modified Mayo Wrist Score four of five wrists achieved a good and one a fair result.The DASH Score averaged 19 (6-59) points.


CONCLUSIONS
The applied treatment resulted in stable, mobile wrists with reasonable alignment and nearly even articular surfaces. The functional results were similar to those reported by other authors for less complex distal radius fractures. This strategy seems to be a rational approach to the reconstruction of severely comminuted intra-articular fractures of the distal radius.
Rhönklinikum, Salzburger Leite 1, 97616, Bad Neustadt a.d. Saale, Deutschland. t.pillukat@bdc.de
T
T
Pillukat
M
M
Schädel-Höpfner
J
J
Windolf
K-J
KJ
Prommersberger
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000295:instrumentation* / Q000379:methods; D001864:Bone Wires; D005260:Female; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D020127:Recovery of Function; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult