External fixation of the distal end of the radius: the same technique for different patient populations?

A series of 56 consecutive patients with 59 fractures of the distal end of the radius, treated with a unilateral Hoffmann external fixator between 1980 and 1988, is presented. Forty-seven of these patients underwent clinical re-examination at home. We could distinguish two different groups of patients: an older female group with an average age of 59.2 years and a younger male group with an average age of 40.1 years. The fractures in the women were caused by lower energy trauma than those in the men (P less than 0.05). The men had significantly more complex fractures (Frykman type VII or VIII) than the women (P less than 0.05). The indications for external fixation were significantly different in men and in women (P less than 0.01). The external fixator remained in place for an average of 5.7 weeks. The injured wrist had on average 71% of the strength of the contralateral wrist. Eighty-seven percent of the patients had no complaints in performing their daily activities. In 70% X-ray showed anatomical reduction, in 64% there was an excellent cosmetic result and in 68% the functional end results were excellent or good. Functional end results can be ameliorated by paying more attention to anatomical reconstruction of the wrist joint. It may be necessary to supplement the external fixation with open reconstruction of the wrist joint and/or a cancellous bone transplant. In some cases, a change of procedure to plate osteosynthesis could be the treatment of choice.