Evaluation of functional outcome of distal end radius fractures managed with external fixation methods: A cross-sectional study

Fractures of distal end radius are most common fractures of upper limb, consisting more than 17.5% of all fractures. Distal radial fractures have a bimodal type of age distribution both in younger and elderly population. Women aged 60 and older are most likely to suffer from fractures of distal radius.

A lower amount of strong cortical bone and higher amount of weaker cancellous bone are main reasons for the metaphyseal widening of the distal radius and predisposed it to fractures. The major risk factors are osteoporosis and a tendency to fall. Therefore, a fracture of the distal radius is typically the result of a fall on the outstretched arm in a post menopausal woman.

Until about 60 years ago, it was general conception that most distal radial fractures could be treated conservatively. Only recently, it was clinically proved that surgical correction of intra-articular step-off and radial shortening had improved patient outcome. These issues are not for elderly people who have low functional and physical demand. In general anatomic reduction should be followed in younger and high-demand elderly patients to initiate early mobilization with extra-articular or intra-articular fractures. Surgical management may also required for low-demand elders with severely displaced intraarticular fracture or median nerve compression but the prime focus for these patients should be on joint movement.

Plating, intramedullary fixation, external fixation or pinning are commonly used for irreducible extra-articular fractures, intra articular fractures and for demanding patients who require early mobilization. Close reduction and cast immobilization which are the principal mode of management of distal radius fractures but it may lead to fracture malunion and subluxation /dislocation of distal radio ulnar joint, resulting in poor outcomefunctionally, radiographic and cosmetically results. The residual worse deformity of wrist adversely affected wrist motion and hand function, thereby interfering with the mechanical advantage of extrinsic hand musculature. It also cause pain, limitation of forearm motion, and decreased grip strength as a result of arthrosis of the radiocarpal and distal radioulnar joints.

The external fixator used commonly in the treatment of distal radius fractures and also for various injuries about the wrist. The addition of K-wires to an external fixation has been proven to have increased rigidity. Comminuted fracture patterns often difficult to reduce and maintain the reduction over time. So, additional K-wires are providing additional stability to the fracture site.

Now, the trend is towards open reduction and internal fixation (ORIF) and away from external fixation. However, we believe that, external fixation is a valuable tool for treatment of fracture and through this review we will show its effectiveness.

Our study deals with the radiological assessment of the post-operative fixation of the fractures, done using X-rays. Standard anteroposterior and lateral views taken to assess fracture pattern and to assess the parameters like palmar tilt, radial height, radial inclination, displacement and involvement of radio carpal and distal radio-ulnar joints.