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Multiplanar Fixation System for the Treatment of Complex Intra-articular Distal Radius Fractures
Ather Mirza, MD, Justin B. Mirza, DO
Ather Mirza, MD, Smithtown, NY

Introduction:

This study aims to assess the outcomes of complex, intra-articular distal radius fractures (AO type C) treated with closed reduction, cross pin multiplanar fixation and a non-spanning external fixator. The use of this device was hypothesized to maintain anatomic reduction and allow for range of motion in AO type C DRFs, as assessed via radiographic variables, functional outcomes and DASH score.

Materials and Methods:

23 patients with complex, intra-articular (AO type C) distal radius fractures (DRFs) were included in this study. All patients were treated with closed reduction and percutaneous fixation using K-wires attached to a non-spanning external fixator. Postoperatively, a removable orthosis was applied, mean 6 days (range 2-10) and formal wrist rehabilitation began, mean of 8 days (range 2-16). Standard radiographs were obtained pre-op, post-op, at 8-12 weeks and 10-14 months. Radiographic variables were measured at each time point from digitized radiographs using Digimizer software. Patients were also evaluated for grip strength, pinch strength and active wrist range of motion (AROM). The Patient-Rated Wrist Hand Evaluation (PRWHE) and the Disabilities of the Arm, Shoulder and Hand (DASH) were used to determine subjective outcomes. Differences between numerical pre- and post-operative variables were analyzed using Student’s T-test. All T-tests were paired, two-tailed tests and statistical significance was set at P < 0.05.

Results:

At average follow-up of 17 months (range 12-36), grip and lateral pinch strength recovered 82.2% and 95.1% respectively, mean wrist AROM increased to a minimum of 82% of the non-injured side; mean DASH and PRWHE scores at last follow up were 10.8 and 9.1 respectively. There was no loss of reduction and no significant change in radiographic parameters following reduction, (P>0.33) although parameters were slightly outside of accepted ranges in three patients. There were no pin track infections, non-unions, tendon injuries or angular collapses. Two patients had an increase in ulnar variance. One patient developed complex regional pain syndrome which resolved and one patient had mild transient superficial radial nerve sensitivity without functional compromise. All patients returned to their prior employment and/or activities.

Conclusions:

23 patients with complex intra-articular DRFs were treated with closed reduction, cross pin fixation and a non-spanning external fixator. Subsequently, patients demonstrated excellent radiographic, functional and subjective outcomes (Final DASH of 10.8). Two patients experienced complications that resolved without functional compromise. This preliminary study suggests that the non-spanning external fixator may be indicated for complex intra-articular DRFs if closed reduction is possible.


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