Study of Fracture Patterns of Distal End Radius and Comparison of Treatment Between Percutaneous Pinning and Volar LCP System

Abstract

BACKGROUND Distal radius fractures accounts for 16% of skeletal and 74% of forearm fractures. Prevalence is more among females, with progressive increase in age complications arises as osteopenia and osteoporosis become more prevalent. The most common trauma mechanism is falling over the outstretched hand. The characteristics of such fractures (trace location, possible joint involvement, comminution and degree of soft tissue injury) are directly related to the force of the trauma, wrist angle at the moment of the trauma and bone health. There is no uniform consensus on the definite choice of treatment. A randomised prospective and retrospective study was undertaken to compare closed reduction and k wire fixation and open reduction and internal fixation with volar LCP and evaluated in terms of functional outcome, the rate of nonunion, malunion and local complications in patients with distal end radius fractures. MATERIALS AND METHODS Patients with distal end radius fractures (AO type A2 A3 B1 C2 C3) in age group of 12 to 78 years were recruited and randomly allocated into two groups, consisting 30 patients each. Group 1 patients were treated surgically by open reduction and internal fixation with volar LCP with whereas patients of group 2 were managed with closed reduction and k wire fixation. Follow-up was done at 06 weeks, 03 months and 06 months 9 months, 15 months, 20 months, their radiographic assessment was done and other complications were evaluated. Finally, functional outcomes were assessed at final follow up visit using "Demerit point rating system" of Gartland & Werley. RESULTS In group 1, results were excellent in 63.3% (19) cases, good in 23.3% (7) cases, fair in 13.3% (4) cases whereas in group 2 results were excellent in 46.7% (14) cases, good in 23.3% (7) cases, fair in 23.3% (7), poor in 6.7% (2) cases as per Gartland & Werley score. In group 1, 2 patients developed superficial infections which was resolved with antibiotic and dressing whereas in group 2, patients developed pin tract infection leading to removal of k wire.in group 1 2 patients suffered from grade 1, 2 arthritis whereas in group 2 2 patients suffered from grade 2, 3 arthritis. Finally modified Gartland & Werley demerit score for group 1 was 3.67, whereas for group 2 was 6.5. CONCLUSION Open reduction and internal fixation with volar LCP gave superior results as compared to closed reduction and k wire fixation in management of distal end radius fractures in terms of union and function.