Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 2 , ISSUE 1 ( January-June, 2020 ) > List of Articles


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

Prabhakar Sekar

Citation Information : Sekar P. Unstable Intra-articular Fracture Distal Radius Managed by Combined External Fixation and Internal Fixation by Volar Plating. 2020; 2 (1):31-37.

DOI: 10.5005/jp-journals-10079-1025

License: CC BY-NC 4.0

Published Online: 17-10-2020

Copyright Statement:  Copyright © 2020; The Author(s).


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.

  1. Altissimi M, Antenucci R, Fiacca C, et al. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthoped Relat Res 1986;206(206):202–210.
  2. Green DP. Pins and plaster treatment of comminuted fractures of the distal end of the radius. J Hand Surg [Am] 1975;57A(3): 304–310.
  3. Naidu SH, Capo JT, Moulton M, et al. Percutaneous pinning of distal radius fractures: a biomechanical study. J Hand Surg [Am] 1997;22A(2):252–257. DOI: 10.1016/S0363-5023(97)80159-1.
  4. Saeki Y, Hashizume H, Nagoshi M, et al. Mechanical strength of intramedullary pinning and transfragmental Kirschner wire fixation for Colles’ fractures. J Bone & Joint Surgery 2001;26B(6):550–555. DOI: 10.1054/jhsb.2001.0646.
  5. Vaughan PA, Lui SM, Harrington LS. Treatment of unstable fractures of the distal radius by external fixation. J Bone Joint Surg 1985;67(3): 385–389. DOI: 10.1302/0301-620X.67B3.3997946.
  6. Jakim PH, Sweet MB. External fixation for intra-articular fractures of the distal radius. J Hand Surg [Am] 1991;73B(2):302–306.
  7. Goslings JC, DaSilva MF, Viegas SF, et al. Kinematics of the wrist with a new dynamic external fixation device. Clin Orthopaed Relat Res 2001;386(386):226–234. DOI: 10.1097/00003086-200105000-00030.
  8. Jakob M, Rikli DA, Regazzoni P. Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg 2000;82B(3):340–344. DOI: 10.1302/0301-620x.82b3.10099.
  9. Fitoussi F, Ip WY, Chow SP. Treatment of displaced intra-articular fractures of the distal end of the radius with plates. J Hand Surg [Am] 1997;79A(9):1303–1312. DOI: 10.2106/00004623-199709000- 00004.
  10. Carter PR, Frederick HA, Laseter GF. Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg [Am] 1998;23A(2):300–307. DOI: 10.1016/S0363-5023(98)80131-7.
  11. Jupiter JB, Lipton H. The operative treatment of intraarticular fractures of the distal radius. Clin Orthop 1993;292(292):48–61. DOI: 10.1097/00003086-199307000-00008.
  12. Howard PW, Steward HD, Hind RE, et al. External fixation or plaster for severely displaced comminuted Colles‘ fractures? J Bone Joint Surg Br 1989;71(1):68–73. DOI: 10.1302/0301-620X.71B1.2915010.
  13. Malone KJ, Magnell TD, Freeman DC, et al. Surgical correction of dorsally angulated distal radius malunions with fixed angle volar plating: a case series. J Hand Surg Am 2006;31(3):366–372. DOI: 10.1016/j.jhsa.2005.10.017.
  14. Kömürcü M, Kamaci L, Ozdemir MT, et al. Treatment of AO type C2-C3 fractures of the distal end of the radius with external fixation. Acta Orthop Traumatol Turc 2005;39(1):39–45.
  15. Dicpinigaitis P, Wolinsky P, Hiebert R, et al. Can external fixation maintain reduction after distal radius fractures? J Trauma 2004;57(4):845–850.
  16. Bass RL, Blair WF, Hubbard PP. Results of combined internal and external fixation for the treatment of severe AO-C3 fractures of the distal radius. J Hand Surg [Am] 1995;20(3):373–381. DOI: 10.1016/S0363-5023(05)80090-5.
  17. Pradhan RL, Lakhey S, Pandey BK, et al. External and internal fixation for comminuted intra articular fractures of distal radius. Kathmandu Med J 2009;7(28):369–373. DOI: 10.3126/kumj.v7i4. 2756.
  18. Zhang Q-L, Zhu X-D, Li G-D, et al. Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator. Med J 2009;122(13):1517–1520.
  19. Rogachefsky RA, Lipson SR, Applegate B, et al. J Bone Joint Surg Am 2001;83(4):509. DOI: 10.2106/00004623-200104000-00005.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.