External Fixation for Wrist Fractures - Rob Sneath - 27/3/2003

Author

Steffen ( Montreal ), Eugster and Jakob R.P.

Title

Twelve years follow-up of fractures treated with the AO external fixator

Reference

Injury 25:Suppl 4;S-D44-54 1994

Summary

32 pts with intra-articular fractures. Ave follow up 11.6yrs. Ave age 53.9yrs. 82% had C2 or C3 #'s. Rated for pain, motion, strength, deformity and X-Ray appearance. No clear progressive loss of movement over time. 75% did not show progressive OA changes. Over 2mm articular step - significant tendency to have OA and more severe type. Die-punch fragment not a predictor of OA. Wrist function mostly affected by radial shortening.

Critique

Longest follow up study. Small sample, different assessors, several surgeons. By their own admission final conclusions can not be drawn.

Author

Sommerkamp T. G. ( Dallas ), Seeman M., Silliman J., et al.

Title

Dynamic external fixation of unstable fractures of the distal part of the radius

Reference

JBJS 76-A:8;1149-1161 Aug 1994

Summary

Prospective randomised study comparing dynamic with static for unstable distal radial fractures. Clyburn dynamic fixator group “ 38 #'s ave age 34yrs. AO/ASIF group “ 37 #'s ave age 39yrs. High energy fractures selected. Fixators in both groups kept in position for 10 weeks. Assessed clinically and radiographically at 1, 6 and 12 months. Dynamic mobilisation of the wrist resulted in significant loss of radial length and an increased complication rate with no evidence of clinical benefit.

Critique

Very thorough methodology. Relatively small numbers. Group of young patients with high energy injuries makes comparison with other studies difficult.

Author

McQueen M. M. ( Edinburgh ), Hajducka C., and Court-Brown C. M.

Title

Redisplaced unstable fractures of the distal radius “ A prospective randomised comparison of four methods of treatment

Reference

JBJS 78-B:3;404-409 May 1996

Summary

30 patients in each group. Grp 1 “ forearm cast, Grp 2 “ open reduction and bone grafting. Grp 3 “ Pennig external fixator 6 weeks. Grp 4 “ Pennig fixator dynamised at 3 weeks for a total of 6 weeks. Assessed clinically and radiologically at 6 weeks, 3, 6, 12 months. No difference in functional outcome

Take away message

No regime consistently restored palmar tilt and normal carpal alignment, which are probably the most important factors of outcome

Author

McQueen M. M. ( Edinburgh )

Title

Redisplaced unstable fractures of the distal radius “ A randomised, prospective study of bridging versus non-bridging external fixation

Reference

JBJS 80-B:4;665-669 July 1998

Summary

Similar study design to her previous one with 60 pts this time. Non-bridging group had a significantly better radiological and functional outcome.

Take away message

Ligamentotaxis does not restore volar tilt with any certainty due to the short tough volar ligaments. Recommended if there is sufficient space in the distal fragment.