Treatment of comminuted distal radius fractures: an approach based on pathomechanics

Following dorsally displaced fractures of the distal radius, the classic position of immobilization is with the wrist flexed and in ulnar deviation. This is not the position of function and entails morbidity in the form of finger stiffness, which may require prolonged rehabilitation. We treated 20 consecutive, comminuted, intraarticular distal radial fractures using a new external fixation system with the wrist in a neutral to extended position, thereby promoting metacarpophalangeal joint flexion by relatively relaxing the finger extensor tendons. Supplemental pin fixation was used in eight cases. Most patients were performing active digital motion on the day of surgery and 95% maintained functional finger motion during treatment. All fractures healed uneventfully. Palmar tilt was restored in 55% of patients in spite of a wrist neutral or extended position. This method of fixing distal radial fractures allows restoration of anatomy while avoiding hand stiffness.