External fixation of distal radius fractures. Indications and technical principles

External fixation of unstable intra-articular fractures of the distal radius has become an effective tool in the management of these difficult injuries. Careful assessment of the fracture pattern, appropriate patient selection, meticulous surgical technique, the appropriate choice of fixation device and pins, recognition of the need for augmentation with limited internal fixation or bone grafting, and aggressive postoperative rehabilitation provide the foundation for successful management of these fractures while minimizing complications. The surgeon must remember that the pin-bone interface is the link between the patient and the fixator. He or she must ensure a stable environment for this interface by providing a clean, tight purchase of the pin in bone with minimal damage to the bone and its surrounding soft tissues at the time of operation. Postoperatively, the surgeon must convey to the patient the importance of maintaining a healthy environment for this pin-bone interface. An appropriately chosen external fixation device can be expected to provide overall stability while maintaining length as well as angular and rotational alignment. However, it cannot be expected to provide precise small fragment control and restoration of articular congruity. This must be achieved by precise reduction and limited internal fixation using Kirschner wires while prevention of late collapse is afforded by subarticular bone grafting of the metaphyseal defect. Adherence to these principles should provide a satisfactory outcome with a significant reduction in the rate of complications when external fixation is used for the management of complex fractures of the distal radius.