Management of Comminuited Intra/Juxta Articular Fracture of Distal Radius Using Bridging External Fixator

Background: Distal radius fractures are the third most common osteoporotic fractures and are frequently treated in emergency department. They have a trimodal peak of occurrence and there has been a significant increase in incidence of involvement in elderly females and young males. Management of these fractures comes with lots of treatment options and challenges to provide good functional outcome. This prospective study was done for the management of communited intra/juxta articular fractures of distal end radius using a bridging external fixator on 25 patients. The principle of ligamentotaxis was used for alignment of fracture fragments and wrist spanning external fixator was used to maintain the fracture reduction.Methods:25 patients of either sex with age group 16 to 80 years were taken from the orthopedic department. After proper primary care, cases were classified using Fernandez classification, and posted for surgery as soon as investigations and fitness were taken.Results:Patients involved in the study were in range of 16 to 78 years with 16 patients having dominant side with road traffic accident as leading cause.Radiological union was seen at an average of 7.3 weeks, 4 patients had superficial pin tract infection, 3 patients had stiffnes and a single case had malunion. Conclusions:Modified clinical scoring system of Green and O’Brien was used to evaluate the overall functional results which showed excellent to good results in 84% of cases. Hence, properly planned and executed bridging external fixator is an easy, cost-effective and reliable treatment modality through the “Principle of Ligamentotaxis”.

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External fixator by Mitkovic in the treatment of comminuted intraarticular fractures of the distal radius

Medicinski pregled ◽

10.2298/mpns0410473m ◽

2004 ◽

Vol 57 (9-10) ◽

pp. 473-479 ◽

Cited By ~ 2

Author(s):

Ivan Micic ◽

Milorad Mitkovic ◽

Desimir Mladenovic ◽

Sasa Karalejic ◽

Sasa Milenkovic ◽

...

Keyword(s):

Distal Radius ◽

External Fixator ◽

Wrist Joint ◽

Functional Results ◽

Kirschner Wires ◽

Articular Fractures ◽

Intraarticular Fractures ◽

Anatomic Reduction ◽

Joint Incongruity ◽

The Moment

Introduction Comminuted intraarticular fractures of the distal radius metaphysis are a major challenge for orthopedic surgeons. The aim of this study was to present results of the survey on treatment of these fractures using an external fixator. Material and methods 73 patients (30 females and 43 males) with closed comminuted intraarticular fractures of the distal radius, type C AO/ASIF (based on radiography at the moment of injury) were treated by a Mitkovic external fixator and followed-up for at least 2 years. An external fixator and Kirschner wires were used in 43 patients. An external fixator without Kirschner wires was used in 30 patients. Results At the end of treatment, functional results and outcomes were excellent in 39 (53.4%), good in 19 (26%), fair in 10 (13.7%), and poor in 5 (6.8%) patients according to Jakim score. Lesser degree of limitation of the movement of the wrist joint was established in 19 patients (26%). Joint incongruity of the distal radius, 0-2 mm, was observed in 22 patients (30%) and over 2 mm in 3 patients. A minimal degree of posttraumatic osteoarthrosis was recorded in 21 patients (28.7%) and moderate ostheoarthrosis in 5 patients (6.8%). Conclusion The anatomic reduction of the articular surfaces and healing of the fracture in a proper functional position are prerequisites for adequate function of the wrist and hand. It appears that an external fixator, with or without Kirschner wires, can be a method of choice in treatment of these complex articular fractures.

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Outcome of unstable fractures of the distal end of the radius treated with external fixator

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v10i2.12950 ◽

2015 ◽

Vol 10 (2) ◽

pp. 27-32

Author(s):

HK Gupta ◽

R Shrestha ◽

SK Shrestha

Keyword(s):

Prospective Study ◽

Distal Radius ◽

External Fixator ◽

Treatment Options ◽

Cost Effective ◽

Point System ◽

Unstable Fracture ◽

Medical Sciences ◽

Back Ground ◽

Lost To Follow Up

BACK GROUND AND OBJECTIVES Fracture of the distal radius is the most common fracture treated by the orthopedic surgeons. Although there are several treatment options available today, the aim always remains to restore the anatomy and bring back the function to near normal condition. In this prospective study we intend to evaluate the functional and radiological outcome of the unstable fracture of the distal radius when treated with external fixator. MATERIALS AND METHODS In this hospital based, Prospective study conducted in department of Orthopedics, College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan, during the period from January 2011 to September 2012, 54 patients, (33 male and 21 female) with unstable fracture of the distal end of radius were included in the study. All the patients were treated with external fixator and followed for a period of 12 weeks. RESULT Among 54 patients, 52 were followed up for 12 weeks and two patients were lost to follow up after six weeks. The final result was assessed in detail on the basis of Modification, by Sarmiento et al., of the Demerit Point system of Gartland and Werley at the end of 12 weeks. The result was excellent in 25 cases, good in 19 cases and fair in eight cases. There were no poor results in this series. CONCLUSION External fixator is not only easy to use, allows re-reduction, has lower rate of complications and can be stiff enough to maintain the alignment but it is also a cost effective, patient compliant method which causes lesser morbidity to the patient as compared to the other options available.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12950Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 27-32

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INTRA-ARTICULAR FRACTURES OF DISTAL RADIUS;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.04.2307 ◽

2018 ◽

Vol 21 (04) ◽

pp. 649-653

Author(s):

Waqar Alam ◽

Faaiz Ali Shah ◽

Khalid Mahmood Qureshi ◽

Shams Ur Rehman ◽

Shahid Hussain ◽

...

Keyword(s):

Distal Radius ◽

External Fixator ◽

Functional Results ◽

Distal Radius Fractures ◽

Monthly Interval ◽

Point System ◽

Functional Evaluation ◽

Radius Fractures ◽

Articular Fractures

Objective: To assess the radiological and functional outcome of external fixator inthe treatment of intar-articular fractures of distal radius. Study design: Descriptive case series.Place and duration of study: Orthopaedic unit District Headquarter Hospital Temargarha LowerDir from March 2013 to March 2014. Material and methods: Twenty five patients of intra-articularfracture distal radius fulfilling the inclusion criteria were treated with AO external fixator byligamentotaxis. Preoperative and postoperative radiograph measurements were taken of radialinclination, radial tilt, and radial length, and fractures were classified according to the AO system.The fixator was removed after 6-8 week and functional assessment was done using Gartland andWerely point system at monthly interval for six months. Results: Eighteen male (72%) and 7(28%)females mean age 43.1 years with intra-articular distal radius fractures were treated with externalfixator. Preoperative mean radial inclination(10.5 degree) radial tilt(29 degrees dorsal) and radiallength(6.3 mm) were reported postoperatively as 18.8 degrees,8 degrees volar and 10 mmrespectively at final follow up visit. The functional evaluation by Gartland and Werley's pointsystem reported excellent (60% patients) ,good(20%) and fair(12%) at final follow up visit. One(4%) patient could not achieve union while one (4%) malunion was reported. Conclusions:Bridging external fixator(static) yields excellent radiological and functional results in majority ofintra-articular distal radius fractures.

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Pharmacologic treatment of osteoporosis – 2011

Orvosi Hetilap ◽

10.1556/oh.2011.29111 ◽

2011 ◽

Vol 152 (33) ◽

pp. 1320-1326 ◽

Cited By ~ 2

Author(s):

Péter Lakatos

Keyword(s):

Bone Loss ◽

Fracture Risk ◽

Hormone Replacement ◽

Treatment Options ◽

Osteoporotic Fractures ◽

Cost Effective ◽

Similar Efficacy ◽

High Fracture ◽

Efficient Treatment ◽

Treatment Of Osteoporosis

Osteoporosis affects approximately 9% of the population in Hungary resulting in about 100 000 osteoporotic fractures annually. Thirty-five percent of patients with hip fractures due to osteoporosis will die within 1 year. Direct costs of osteoporosis exceed 25 billion forints per year. Apparently, cost-effective reduction of bone loss and consequent fracture risk will add up to not only financial savings but improvement in quality of life, as well. A number of pharmacological modalities are available for this purpose. The mainstay of the treatment of osteoporosis is the bisphosphonate group that includes effective anti-resorptive compounds mitigating bone loss and fragility. The recently registered denosumab exhibits similar efficacy by neutralizing RANK ligand, however, marked differences can be observed between the two drug classes. Strontium has a unique mechanism of action by rebalancing bone turnover, and thus, providing an efficient treatment option for the not fast bone losers who are at high fracture risk. The purely anabolic teriparatide is available for the extremely severe osteoporotic patients and for those who do not respond to other types of therapy. Older treatment options such as hormone replacement therapy, raloxifene, tibolone or calcitonin may also have a restricted place in the management of osteoporosis. Orv. Hetil., 2011, 152, 1320–1326.

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Use of Cobra External Fixator for treatment of Distal Radius Fractures

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i6.20594 ◽

2018 ◽

Vol 9 (6) ◽

pp. 84-89

Author(s):

Niraj Ranjeet ◽

Pratyenta Raj Onta ◽

Krishna Sapkota ◽

Pabin Thapa ◽

Krishna Wahegoankar ◽

...

Keyword(s):

Distal Radius ◽

External Fixator ◽

Treatment Options ◽

Distal Radius Fractures ◽

Medical Sciences ◽

Radius Fractures ◽

Ao Classification ◽

Functional Activities ◽

Clavicle Fractures

Background: Distal radius fractures are one of the commonest injuries only after clavicle fractures. These fractures poses challenges to the treating surgeons as a result of which these fractures are sometime treated unacceptably and leads to poor outcome. Among various treatment options for these fractures wrist sparing Cobra external fixator is one of the options with an impressive stability and outstanding functional outcomes.Aims and Objectives: To determine whether this system can achieve adequate reduction of a variety of DRF, is able to maintain reduction despite hand and wrist movements, whether it compromises hand and wrist functions and leads to long term problems.Materials and Methods: From July 1, 2016 - June 30, 2017, all skeletally matured patients with acute distal radius fractures (AO-A2, B1, C1, C2) were adequately reduced and fixed with Cobra ex-fix. Immediately post-op patients were encouraged to start range of motion of the wrist as the pain decreased. The patients were followed up in 2,4 and 8 weeks and were analyzed clinically, radiologically, their functional outcomes and any complications.Results: Twenty-two patients were included in our study. Nine were males and 13 were females. Using the AO classification, 15 were classified as A2, 2 were B1, 3 were C1, and 2 were C2. The mean number of weeks the cobra fixator was maintained was 5.3 weeks. The Cobra ex-fix was able to achieve excellent maintenance of radial height and radial inclination and good maintenance of dorsal tilt. Recovery of functional activities according to Gartland and Werley’s functional scoring system was good to excellent in all patients at 8 weeks follow-up.Conclusion: The Cobra external fixation system is an outstanding device for use in fractures of the distal radius. It achieves superior anatomic correction and is dependable in maintaining fracture reduction even with hand and wrist use.Asian Journal of Medical Sciences Vol.9(6) 2018 84-89

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Evaluation of a Novel, Nonspanning External Fixator for Treatment of Unstable Extra-articular Fractures of the Distal Radius: Biomechanical Comparison With a Volar Locking Plate

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3180eea9f0 ◽

2008 ◽

Vol 64 (4) ◽

pp. 975-981 ◽

Cited By ~ 11

Author(s):

Eric J. Strauss ◽

Devraj Banerjee ◽

Frederick J. Kummer ◽

Nirmal C. Tejwani

Keyword(s):

Distal Radius ◽

External Fixator ◽

Locking Plate ◽

Volar Locking Plate ◽

Articular Fractures ◽

Biomechanical Comparison

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Functional outcome of intra-articular fractures of distal radius using external fixator: A long term study

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v7i3.240 ◽

2019 ◽

Vol 7 (3) ◽

Author(s):

Dr Manzoor A Halwai ◽

Keyword(s):

Functional Outcome ◽

Distal Radius ◽

External Fixator ◽

Term Study ◽

Long Term Study ◽

Articular Fractures

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Study on functional outcome of distal radius intra-articular fractures managed by ligamentotaxis: a cross sectional study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194153 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1094

Author(s):

Karu Shanmuga Karthikeyan

Keyword(s):

Functional Outcome ◽

Distal Radius ◽

Functional Outcomes ◽

Cost Effective ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Multiple Treatment ◽

Articular Fractures ◽

Study Population

Background: Fractures of the distal radius continue to be the one of the most common skeletal injuries treated by an orthopaedic surgeon. They are the most common fractures of the upper extremity and account for 15-20% of all fractures. All intra articular fractures need good reduction for better functional outcome. There are multiple treatment methods from casting to arthroscopic surgeries. This study has been undertaken to study the functional outcomes of distal radius intra-articular fractures managed by ligamentotaxis. The objective of the present study was to evaluate the functional outcomes of distal radial intra-articular fractures treated by ligamentotaxis.Methods: This cross sectional study was conducted in Orthopaedic department of Kilpauk Medical College between April 2017 to April 2019 on 60 patients with fracture of the distal end of radius, with comminuted fracture, who fulfilled the inclusion and exclusion criteria were included in the study. All fractures were managed by ligamentotaxis and were followed regularly and assessed after four months for their functional outcomes.Results: 80% of the study population were males. Around 67% of the study population had type III or type IV fracture according to Frykman’s classification. 84% of the study population had better prognosis with ligamentotaxis. The difference between mean Mayo wrist score between affected side and normal side was not statistically significant.Conclusions: Ligamentotaxis, external fixation for comminuted intra articular distal radius fractures is safe and effective treatment. It is also cost effective.

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