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[Outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire fixation]
Minghui Yang1, Shiwen Zhu1, Zhiqiang Gao1
1Department of Traumatology & Orthopedics, Beijing Jishuitan Hospital, Fourth Medical College, Peking University, Beijing 100035, China.
Objective:
To explore the clinical outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire.
Methods:
Retrospective reviews were conducted for 9 patients with open distal radius fractures managed with bridging external fixator and Kirschner-wire between October 2009 and October 2010. There were 6 females and 3 males with a mean age at injury of 60.0 (17-79) years. The mechanisms were fall from standing height (n = 5), fall from height >2 meters (n = 1) and traffic accident (n = 2). The average time from injury to operation was 7.2 (4-9) hours. According to the Gustilo and Anderson classification, the grades were I (n = 2),II (n = 3) and IIIA (n = 4). Two patients had additional injuries in other areas.Four patients had associated tendon, nerve or artery injury around wrist.One patient had ipsilateral forearm compartment syndrome. The clinical and radiological outcomes were followed.
Results:
According to the AO/OTA classification, there were A2 (n = 1),A3 (n = 4) and C3 (n = 4).Seven patients had distal ulnar fractures and 4 suffered a dislocation of DRUJ (distal radial ulnar joint). All distal radius fractures were fixed with bridging external fixator and Kirschner-wire. Percutaneous pin fixation of DRUJ was performed in 4 patients because of instability of radial or ulnar fractures.Nine patients were followed up for an average period of 2.8 (1.9-3.5) years. According to the modified Green and O'Brien score, the clinical outcome at the time of final follow-up was graded as excellent (n = 2), good (n = 4), fair (n = 1) and poor (n = 2). All fractures were healed. The complications included fixation failure and revision (n = 1), fixator pin site infection (n = 2) and Kirschner-wire loosening (n = 5).
Conclusions:
The outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire are unsatisfactory. And this fixation method may not be optimal for all open distal radius fractures.
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