FACTORS AFFECTING FUNCTIONAL OUTCOME OF DISPLACED INTRAARTICULAR DISTAL RADIUS FRACTURES

Open reduction and internal fixation is often required in comminuted, displaced intra-articular fractures of the distal radius when closed m anipulation has failed to restore articular congruity. Results of surg ical stabilization and articular reconstruction of these injuries are reviewed in this retrospective study of 49 patients with 52 displaced, intra-articular distal radius fractures. Forty-three patients with a mean age of 37 years (range, 17-79 years) were available for evaluatio n. The mean follow-up time was 38 months (range, 22-69 months). When r ated by the system proposed by the Association for the Study of Intern al Fixation (ASIF), 19 were ASIF type C2 and 21 were ASIF type C3. An injury score system based on the initial injury x-ray films was used t o classify severely comminuted intra-articular fractures and to identi fy those associated with carpal injury. Postoperative fracture alignme nt, articular congruity, and radial length were significantly improved following surgery. Grip strength averaged 69+/-22% of the contralater al side, and range of motion averaged 75+/-18% of the contralateral si de after surgery. A combined outcome rating system that included grip strength, range of motion, and pain relief averaged 76+/-19% of the co ntralateral side. Using regression analysis, a significant decrease wa s found in the combined rating with more severe fracture patterns as d efined by the AS[F system, Malone classification, and the injury score system. The injury score system presented here and, in particular, th e number of fracture fragments correlated most closely with the outcom e of all classification systems examined. Operative treatment of compl ex distal radius fractures with reconstruction of articular congruity with internal fixation and/or external fixation can significantly impr ove functional outcome. The degree to which articular step-off, gap be tween fragments, and radial shortening are improved by surgery is stro ngly correlated with improved outcome, even when the results are corre cted for severity of initial injury, whereas correction of radial tilt or dorsal tilt did not correlate with improved outcome.