David S Ruch1, Charlie Yang, Beth Paterson Smith. 1. Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA.
Abstract
OBJECTIVES: The study evaluated the outcome of the treatment of patients who sustained high-energy, compression-type injuries of the distal radius. DESIGN: The retrospective study evaluated the outcome of reduction and plating of the lunate facet in conjunction with standard external fixation. SETTING: A Level I trauma center. PATIENTS: Inclusion criteria for study participation included: 1) age between 18 and 65 years of age with no evidence of concomitant metabolic bone disease; and 2) a 3- or 4-part compression type fracture of the distal radius with residual displacement of the palmar lunate facet despite reduction of the dorsal cortex by the application of an external fixator. INTERVENTION: Fractures were treated with palmar plating of the depressed lunate facet combined with dorsal external fixation. MAIN OUTCOME MEASUREMENTS: Posttreatment evaluations consisted of measurements of range of motion, grip strength, radiographic evaluations, and completion of Disability of Arm, Shoulder, and Hand questionnaires. RESULTS: Three months after surgery, 20 of 21 patients exhibited full range of motion at the MCP/PIP joints. At the 2-year follow-up, an average palmar tilt of +1.0 degrees, radial inclination of 24 degrees, radial length of 12 mm, ulnar variance of 0.5 mm, intra-articular gap of 0.1 mm, and intra-articular step-off of 0.3 mm was documented. Using the Garland and Werley rating system, results were rated as excellent or good for 18 wrists, fair for 2 wrists, and poor for 1 wrist. Mean Disability of Arm, Shoulder, and Hand functional scores and athletic scores improved at 6 months. CONCLUSIONS: Reduction and plating of the lunate facet in conjunction with standard external fixation permits: 1) visualization and reduction of the palmar lunate facet; and 2) reduction of palmar tilt to neutral tilt without significant radial shortening. This technique should be considered as an acceptable option in the treatment of high-energy fractures of the distal radius.
OBJECTIVES: The study evaluated the outcome of the treatment of patients who sustained high-energy, compression-type injuries of the distal radius. DESIGN: The retrospective study evaluated the outcome of reduction and plating of the lunate facet in conjunction with standard external fixation. SETTING: A Level I trauma center. PATIENTS: Inclusion criteria for study participation included: 1) age between 18 and 65 years of age with no evidence of concomitant metabolic bone disease; and 2) a 3- or 4-part compression type fracture of the distal radius with residual displacement of the palmar lunate facet despite reduction of the dorsal cortex by the application of an external fixator. INTERVENTION: Fractures were treated with palmar plating of the depressed lunate facet combined with dorsal external fixation. MAIN OUTCOME MEASUREMENTS: Posttreatment evaluations consisted of measurements of range of motion, grip strength, radiographic evaluations, and completion of Disability of Arm, Shoulder, and Hand questionnaires. RESULTS: Three months after surgery, 20 of 21 patients exhibited full range of motion at the MCP/PIP joints. At the 2-year follow-up, an average palmar tilt of +1.0 degrees, radial inclination of 24 degrees, radial length of 12 mm, ulnar variance of 0.5 mm, intra-articular gap of 0.1 mm, and intra-articular step-off of 0.3 mm was documented. Using the Garland and Werley rating system, results were rated as excellent or good for 18 wrists, fair for 2 wrists, and poor for 1 wrist. Mean Disability of Arm, Shoulder, and Hand functional scores and athletic scores improved at 6 months. CONCLUSIONS: Reduction and plating of the lunate facet in conjunction with standard external fixation permits: 1) visualization and reduction of the palmar lunate facet; and 2) reduction of palmar tilt to neutral tilt without significant radial shortening. This technique should be considered as an acceptable option in the treatment of high-energy fractures of the distal radius.