Functional Outcome of Joshi’s External Stabilization System Fixation in Distal Radius Fractures

Abstract

BackgroundDistal radius fractures account for almost one-sixth of all fractures in a casualty setting. The usual aim of distal radius fracture treatment is to restore the function of the wrist joint, of which the distal radius is an important part. There seems to be no consensus regarding which mode of treatment is optimal for managing distal radius fracture, particularly when it is associated with distal radioulnar joint instability. ObjectiveTo describe the functional outcome in patients presenting with displaced distal radius fractures who undergo Joshi's external stabilization system (JESS) fixation. MethodsAn observational study was done among 32 working-age (18 to 55 years) patients presenting with unilateral displaced distal radius fractures (excluding volar displaced) and subsequently treated with JESS fixation. The outcomes of the patients were assessed using the Green and O'Brien Scoring System modified by Cooney et al. at six months and one year following the surgery. Radiographs were also taken postoperatively and during follow-up. The data were analyzed (using IBM SPSS software version 22 and Microsoft Excel) in terms of the proportion of patients with acceptable clinical and radiological outcomes. ResultsAcceptable functional outcomes (good and excellent scores in the Green and O'Brien Scoring System) were observed in 78.1% of the study population. Though the functional outcome scores were higher among the younger age group, a statistically significant difference was not obtained. 96.9% of the patients had acceptable radiological reductions, and infection of the pin tracts complicated 9.4% of the cases. A significant improvement in outcome scores (p-value 0.0001) was observed between the outcome scores at six months and one year after surgery. ConclusionsJESS fixation is an easy and effective method for treating displaced distal radius fractures to achieve good to excellent clinical outcomes. The functional outcome scores were better in the younger age group and male patients, but no statistically significant difference was observed.

Functional outcomes of jess fixator application in fractures of distal end radius: A prospective study

“…Treatment part remains debatable as many treatment modalities are available which are may vary according to different fracture patterns and morphology, different age group, availability of implants and infrastructure, socioeconomic constraints etc. Different modes of treatment for fractures of distal end radius are there including most commonly performed closed manual reduction of fracture of distal end radius and slab or cast application, closed reduction and internal fixation with Kirschner wires (percutaneous pinning or intrafocal pinning) with or without slab / cast support, volar or dorsal plating, external fixation and Joshi's external stabilization system (JESS) depending on the fracture geometry and fracture type [13][14][15] . Collapse, loss of palmar tilt, radial shortening, and articular incongruity are frequent after closed treatment of unstable and comminuted intra-articular fractures of the distal radius, and these often result in permanent deformity, pain, and loss of function [14][15][16][17] .…”

“…Different modes of treatment for fractures of distal end radius are there including most commonly performed closed manual reduction of fracture of distal end radius and slab or cast application, closed reduction and internal fixation with Kirschner wires (percutaneous pinning or intrafocal pinning) with or without slab / cast support, volar or dorsal plating, external fixation and Joshi's external stabilization system (JESS) depending on the fracture geometry and fracture type [13][14][15] . Collapse, loss of palmar tilt, radial shortening, and articular incongruity are frequent after closed treatment of unstable and comminuted intra-articular fractures of the distal radius, and these often result in permanent deformity, pain, and loss of function [14][15][16][17] . In compound and or comminuted intra articular fractures of distal end radius, anatomical reduction of the fracture fragments is the key to better outcome for good functional outcomes.…”

“…The use of transfixing K-wires with external fixation is recommended for severely comminuted fractures. [14,16] Anderson and O Neil were first to maintain fracture reduction with an external fixator using principle of ligamentotaxis. In comminuted fractures plate application has been proven superior in functional outcome than K wire fixation or JESS fixator application in some studies.…”