Author(s): Vidyadhar S. Donimath1, Anant Akash2, Manjunath Barker3
Fractures of the distal end of radius are the most frequently occurring upper skeletal injuries managed by orthopaedic surgeons. Despite continuous refinement in treatment modalities, there is no consensus regarding the same.
MATERIALS AND METHODS
This prospective study was conducted on 80 patients with distal radial fractures after taking informed consent of the patients. Based on the fracture anatomy, different treatment protocols were assigned- a) Closed reduction and plaster cast application; b) Percutaneous K-wire fixation; c) External fixator application; and d) Open reduction and internal fixation with volar plate application. The fractures were classified with Frykman’s classification. During the follow-up, functional parameters were assessed by the demerit point system of Gartland and Werley with Sarmiento et al modification and Mayo’s wrist scoring.
Excellent to good results were obtained in most fractures treated by open reduction and internal fixation with volar plate and external fixation. Reduction was well-maintained, complications were less and functional parameters showed a significant improvement during the follow-up period.
External fixation and volar plating produce almost equivalent functional results in distal radial articular fractures with volar plating having better anatomical results than external fixation in the present study. Volar plate fixation of unstable distal radius fractures provides a stable construct that helps in early mobilisation, thereby achieving better functional outcomes and minimises chances of delayed/malunion. External fixator used for ligamentotaxis is an effective method of treating unstable extra-articular and complex intra-articular fractures of distal radius. Complication such as irregular articular surface, wrist pain, finger stiffness, malunion and K-wire loosening were observed. Thus, based on this study, we conclude that volar plating and external fixation have relatively better outcome for distal end radius fractures with minimum chance of implant failure and complications even in highly comminuted cases and cases having osteoporosis and should be preferred over the conventional treatment methods of percutaneous K-wire fixation and closed reduction with casting.