Unstable distal radial fractures treated by external fixation: an analytical review

A "Hoffman type 2" external fixator was applied in 33 patients being treated for distal radial fractures that were classified according to the three basic types of the AO/ASIF system. Thirty fractures were suitable for statistical evaluation. Fixators were used alone (n = 10) or in combination with internal fixation of the intra-articular component. Fixators were removed sooner when they were combined with internal devices and these patients had significantly less pain. There was no relation between pain, classification, primary displacement, function, position on the radiograph, and Green and O'Brien score. Primary displacement was more important in patients over 50 years of age. Reflex sympathetic dystrophy was associated with fractures of the ulnar head. Ulnar styloid fractures were not related to increased laxity or symptoms at the distal radioulnar joint. There were no signs of intracarpal "instability" in patients less than 50 years of age and the condition caused no specific symptoms. Maintenance of stability was better when grafts were used, but not significantly so. Green and O'Brien scoring was no more informative than a simple ordinal pain ranking system.