Prospective study of unstable distal radius fractures treated with external fixation in Indian rural set-up

Abstract

Aim: Distal radius fracture is common fracture in daily orthopaedic practice accounting for 1/6 th of all the fractures. Conventionally the fractures were treated with closed reduction and immobilization with casts. Even though union of these fractures occurs, they have a very high incidence of going in for malunion and wrist joint instability especially with comminution & intra articular extension cases. Moreover a change in trend to younger age groups as a result of RTA's (road traffic accidents) & trauma is leading to more complicated fractures with intraarticular extension and comminution. Also the importance of anatomical alignment and reconstruction of radiocarpal and radioulnar ulnar joints has been emphasized in recent trends. Hence the management of distal radius fractures changed from universal use of cast immobilisation to operative interventions. Aim of this study is to observe the effect of external fixation for unstable distal radius fractures in rural set up. Materials and methods: Prospective analysis of 30 patients with unstable distal radius fractures, who were operated at MIMS hospital, nellimarla village, vizianagaram district between may 2016 to feb 2017 treated with external fixator. Patient position-supine with arm table support. For external fixation of the wrist we used the 4 mm (small) external fixator system. For pin insertion into the second metacarpal, the distal pin is inserted proximal to the transition of the metacarpal head into the shaft and the more proximal pin is inserted distal to transition of the shaft into the metacarpal base.The proximal two pins are inserted proximal to the muscle bellies of abductor pollicis longus (APL) and extensor pollicis brevis (EPB). Proximal to these muscles, the radial shaft is palpated through the skin between the bellies of the extensor digitorum communis (EDC) and extensor carpi radialis longus/brevis (ECRL/ ECRB) over a distance of 3-4 cm at which the proximal pins inserted into the radial shaft with 4-5cms apart. Longitudinal traction is applied on the thumb and index finger or the distal partial frame to reduce the fracture. T clamps are fixed to bridging rods, first proximally followed by tightening of distal fragment T clamps to maintain the traction and reduction, there by healing of fracture by the principle of ligamentotaxis. Results: Average Mean hospital stay is 4days, there are 13males and 17 females between age group 28-60yrs, 27 cases out of 30 had functional and radiological union by 12weeks (range 6-18 weeks), 2 had pin track infection which were treated successfully with iv antibiotics. 1 patient had deep bone infection and pin loosening which was managed with external fixator removal, long course antibiotics and casing. We followed standard Sarmiento radiological scoring system, Gartland and Werley Score (demerit system) demerit point scoring system, DASH scores, Green & O Brien grade scoring systems to evaluate the end results. Conclusion: External fixation of unstable distal radius fractures can be considered as ef...