Unstable Intra-articular Fracture Distal Radius Managed by Combined External Fixation and Internal Fixation by Volar Plating

Abstract

Background: Combined external fixation and internal fixation of distal radiusfractures is used most commonly to treat injuries with joint surface ormetaphysealcomminution. External fixation aids reduction intraoperatively and facilitates percutaneous or intraoperative manipulation of fracture. Internal fixation maintains precise reduction in critical anatomy, principally the contour and orientation of the articular surface. Postoperatively, the external fixator functions as a neutralization device, preventing fracture collapse and decreasing the biomechanical demands on the internal fixation hardware. Purpose of study: The aim of this study is to see short-term functional and radiological outcome analysis in patients with unstable intraarticular distal radius fracture treated with combined external fixation and open reduction and internal fixation by volar plating. Materials and methods: A total of 25 cases of unstable intra-articular distal radius fracture (AO Type C group) were treated by combined transarticular external fixator and internal fixation by volar plating with supplementary procedures such as primary bone grafting and K-wire fixation if necessary. The abovementioned study was conducted in Government Royapettah Hospital, Chennai-14, from June 2010 to May 2012. The Modified Gartland and Werley Demerit Scoring system was used to evaluate the functional outcome. In most cases, external fixator was left for a period of 6 weeks. Results: There were 25 patients ranging from 20 to 70 years with 16 males and 9 females. The follow-up period was from 12 to 18 months. Accordingly, there were 14 (56%) excellent, 8 (32%) good, 2 (8%) fair, and 1 (4%) poor results. There were very few complications such as one malunion, two superficial radial nerve palsy, and two secondary fracture collapse noted in our series. Conclusion:We conclude that unstable intra-articular fractures of distal radius treated by combined external fixation and internal fixation by volar plating provides high rate of fracture union and high level of patient satisfaction with early return to work.