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External fixation for comminuted intra-articular wrist fractures
E Verhaven1, H De Boeck, P Haentjens
1Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Belgium.
Acta Orthopaedica Belgica
|January 1, 1991
Summary
The small Hoffman external fixator effectively treated complex distal radius and ulna fractures in 87% of patients, correlating positively with grip strength and negatively with osteoarthritis. Most complications were minor and pin-related.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Biomedical Engineering
Background:
- Complex fractures of the distal radius and ulna, particularly Frykman types III, IV, VII, and VIII, present significant challenges in orthopedic management.
- External fixation offers a potential solution for stabilizing these severe injuries, aiming to restore function and minimize long-term complications.
Purpose of the Study:
- To evaluate the efficacy and outcomes of using the small Hoffman external fixator for treating complex distal radius and ulna fractures.
- To assess the correlation between clinical outcomes, radiographic findings (articular incongruity, osteoarthritis), and functional results (grip strength).
Main Methods:
- A cohort of 101 consecutive patients with Frykman type III, IV, VII, and VIII distal radius and ulna fractures were treated with a small Hoffman external fixator.
- Patients were followed up for a mean of 22 months, with assessments including a demerit point system for overall wrist rating, grading of postoperative articular incongruity and osteoarthritis, and grip strength measurement.
Main Results:
- 87% of patients achieved good or excellent outcomes, while 13% had fair or poor results based on the demerit point system.
- Significant correlations were observed between overall scores and postoperative articular incongruity, osteoarthritis, and grip strength (p < 0.01).
- A positive correlation was found between follow-up duration and the grade of osteoarthritis (p < 0.05).
Conclusions:
- The small Hoffman external fixator is an effective treatment for complex distal radius and ulna fractures, yielding good to excellent results in a majority of cases.
- Postoperative articular incongruity and the development of osteoarthritis are significant factors influencing long-term outcomes and grip strength.
- While the complication rate was notable (40%), most issues were minor, transient, and related to the external fixator pins.