INTRAARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS TREATED WITHAN ADJUSTABLE FIXATOR SYSTEM

Twenty-five wrists with comminuted, displaced, intra-articular fractur es of the distal radius were prospectively treated with an adjustable external fixator for an average of 51 days. Twenty fractures (80% [20 of 25] were available for follow-up) in 16 adults (mean age, 34 years) were treated with the Wrist Jack external fixator system (Hand Biomec hanics Lab, Sacramento, CA) and evaluated at a mean follow-up period o f 25 months. Ten patients (12 fractures) sustained high-energy trauma with multiple injuries, while 6 patients (8 fractures) sustained isola ted distal radius fractures. Percutaneous pins supplemented the fixati on in 6 fractures. All fractures were reduced to restore articular con gruity to within 1 mm. At followup, 5% were excellent, 75% good, 20% f air, and none as poor using the demerit point system of Gartland and W erley as modified by Sarmiento. Grip strength averaged 80% of the unaf fected limb. Seventeen of the 20 fractures showed some evidence of art icular incongruity at follow-up evaluation. Restoration of palmar tilt , radial inclination, radial length, and range of motion were at accep table values. Subjective analysis confirmed 85% of the patients to hav e only occasional pain or none at all and 15% to have some pain with w eakness or limitation of motion. Two patients required additional surg ery: 1 underwent a Darrach procedure and the other a tendon transfer f or a rupture of the extensor pollicis longus tendon. Results suggest t hat an external fixator system provides an additional alternative to t he surgical armamentarium for an otherwise difficult fracture fixation problem.