Do All Complex Intra-Articular Distal Radius Fractures Need Plates?
M Ather Mirza, MD
Mirza Orthopedics, Smithtown, NY
Introduction: This study assesses outcomes of complex, intra-articular distal radius fractures (DRFs; AO type C) treated with closed reduction, cross-pin multiplanar fixation, and a non-spanning external fixator. This device was hypothesized to maintain anatomic reduction and allow active wrist range of motion (AROM).
Methods and Materials: Thirty-one patients with complex, intra-articular DRFs were treated with closed reduction and percutaneous fixation (K-wires attached to a non-spanning external fixator). Removable orthoses were applied postoperatively (mean: 6 days, range: 2-13) and wrist rehabilitation began (mean: 8 days, range: 2-15). Radiographs were assessed at pre-op, 10-days post-op, 12 weeks, 1 year, and final follow-up. Variables measured from digitized radiographs (Software: Digimizer). Patients were evaluated for grip strength, pinch strength, and wrist AROM. PRWHE and DASH questionnaires were used for subjective outcomes.
Results: At follow-up (mean: 17 months, range: 12-53), grip strength, lateral pinch, and precision pinch recovered 82.9%, 93.3%, and 89.6%, respectively; mean wrist AROM increased to minimum 82% relative to non-injured side; mean DASH and PRWHE scores at last follow-up 8.36 and 10.65, respectively. Two patients had increased ulnar variance; one developed complex regional pain syndrome that resolved; one had mild transient superficial radial nerve sensitivity without functional compromise. All patients returned to prior employment and/or activities.
Conclusion: Patients treated with closed reduction, cross-pin fixation, and a non-spanning external fixator demonstrated excellent radiographic, functional, and subjective outcomes. This study suggests the non-spanning external fixator may be indicated for complex intra-articular DRFs if closed reduction is possible.
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