A G Schneeberger1, W Y Ip, T L Poon, S P Chow. 1. Department of Orthopaedic Surgery, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China.
Abstract
OBJECTIVE: To determine the ability of open reduction and plate fixation to restore articular congruity in the treatment of fractures of the distal radius with intraarticular comminution and displacement. DESIGN: Prospectively followed series. METHODS: Eighteen consecutive fractures of the distal radius with intraarticular comminution and displacement were treated with open reduction and combined volar and dorsal plate fixation in thirteen, dorsal plate fixation in four, and volar plate fixation in one case. Kirschner wires were added in thirteen fractures and cancellous bone graft was used in four fractures. Articular congruity after a mean follow-up of twenty-three months was assessed using anteroposterior and lateral radiographs. RESULTS: Articular congruity without a two millimeter or more intraarticular stepoff was found at follow-up in fifteen of eighteen cases, without a two millimeter or more gap in nine cases and without a two millimeter or more stepoff or gap in only eight cases. One reason for not having obtained articular congruity in some of the fractures was insufficient intraoperative visualization of the joint surface. Three reduced fractures redisplaced. The reason for loss of intraarticular reduction was considered insufficient stabilization of the distal fragments. In two of the three cases, it was thought that insertion of bone graft would have prevented the loss of reduction. CONCLUSIONS: Articular incongruity after open reduction and plate fixation of comminuted fractures of the distal radius may occur more often than expected. The reduced fracture should be evaluated by intraoperative radiographs. If the reduced joint surface is not entirely visible on the radiographs because of implants or other reasons, oblique radiographs or fluoroscopy should be additionally used. Plate fixation alone does not always provide sufficient stability and cancellous bone graft should be added in cases of metaphyseal bone loss or for stabilization of multiple small articular fragments that cannot be fixed by screws or Kirschner wires.
OBJECTIVE: To determine the ability of open reduction and plate fixation to restore articular congruity in the treatment of fractures of the distal radius with intraarticular comminution and displacement. DESIGN: Prospectively followed series. METHODS: Eighteen consecutive fractures of the distal radius with intraarticular comminution and displacement were treated with open reduction and combined volar and dorsal plate fixation in thirteen, dorsal plate fixation in four, and volar plate fixation in one case. Kirschner wires were added in thirteen fractures and cancellous bone graft was used in four fractures. Articular congruity after a mean follow-up of twenty-three months was assessed using anteroposterior and lateral radiographs. RESULTS:Articular congruity without a two millimeter or more intraarticular stepoff was found at follow-up in fifteen of eighteen cases, without a two millimeter or more gap in nine cases and without a two millimeter or more stepoff or gap in only eight cases. One reason for not having obtained articular congruity in some of the fractures was insufficient intraoperative visualization of the joint surface. Three reduced fractures redisplaced. The reason for loss of intraarticular reduction was considered insufficient stabilization of the distal fragments. In two of the three cases, it was thought that insertion of bone graft would have prevented the loss of reduction. CONCLUSIONS:Articular incongruity after open reduction and plate fixation of comminuted fractures of the distal radius may occur more often than expected. The reduced fracture should be evaluated by intraoperative radiographs. If the reduced joint surface is not entirely visible on the radiographs because of implants or other reasons, oblique radiographs or fluoroscopy should be additionally used. Plate fixation alone does not always provide sufficient stability and cancellous bone graft should be added in cases of metaphyseal bone loss or for stabilization of multiple small articular fragments that cannot be fixed by screws or Kirschner wires.