5.7 Management of complex distal radius and ulna fractures in polytraumatized patients: treatment with a combined external fixator and orif (internal plate)

Abstract

Background: Palmar plating for dorsally displaced radius fractures with a fixed angle implant becomes increasingly popular to avoid soft-tissue problems associated with dorsal plating. Polyaxial screw fixation ensures an optimal subchondral screw placement in the distal fragment. So far there are few reports on this technique. Aim/objective: To determine the early results and complications after open reduction and palmar plating with a new fixed angle implant (Aptus s Radius 2.5 mm). Patients and methods: A prospective consecutive series including 52 fractures of the distal radius (Colles type) treated with the above-mentioned palmar plate was analysed. Mean follow-up was 12 months, the mean age was 60 years. According to the AO classification, 35% were A-and 65% were intraarticular C-fractures. Patient's evaluation included clinical exam, DASHscore and radiographs. Results: Ninety-five per cent of patients were satisfied or highly satisfied. The mean DASH-score was 14 points. Active wrist motion averaged 571 extension, 481 flexion, 361 ulnar deviation, 341 radial deviation, 831 pronation and 851 supination. Grip strength was 88% compared to the other side. X-ray analysis showed an average palmar tilt of 41, a radial inclination of 211 and no radial shortening. Bony union was achieved in all cases without bone grafting. One case of hardware failure was encountered. There were no infections, secondary dislocations, tendon attritions, vascular or neural lesions. Conclusion: Palmar stabilization of distal radius fractures with this new implant is a safe procedure with promising early results and a low complication rate.