[Management of complex intra-articular distal radius fractures with open reduction and internal fixation with double...

In this prospective study we have analysed the clinical outcome of complex distal radius fractures that were reduced by a dorsal approach and fixed with 2 dorsal locking plates.

In the period from January 2006 to June 2008 60 patients with a distal intra-articular instable radius fracture, who were treated with the above mentioned procedure, were prospectively included in this study. All fractures showed signs of a complex and dorsal instability. X-rays and CT scans were taken preoperatively. Follow-up examinations and X-rays were conducted after 6 weeks, 6 months and 1 year. The clinical outcome was measured with the aid of the disability of arm, shoulder and hand (DASH) score (0-100 points). The functional outcome was measured with the Gartland and Wearley score (0-21 points). Subjective pain levels were noted with the visual analogue scale (0-10 points).

60 patients were examined after 6 weeks and 6 months. 40 patients were examined after 1 year. The average age was 56 (range: 16-78 years). In 36% of the cases we found an accompanying injury of the upper extremity that had to be treated operatively. The DASH score improved on average from 47 points after 6 weeks (28 points after 6 months) to 24 points after 1 year. The subjective pain level after 1 year was 2.4 points under stress and 1.1 points in relaxation. The Gartland and Wearley score showed an improvement of function of the wrist from 9.9 points after 6 weeks to 7.4 points after 1 year, which is considered a good result. In 12 cases reoperations were necessary, in 6 cases due to a postoperative carpal tunnel syndrome (10%) and in 1 case due to an infection of the wound.

Dorsal instable radius fractures can be stabilised in a satisfactory way. It is possible to achieve good results, assuming an exact analysis of the fracture and of the associated injuries is performed.