BODYCAST - THE OFFICIAL JOURNAL OF THE CSOT

External fixation in the
management of distal radius fractures

By Brad A. Petrisor and Mohit Bhandari
This article was originally published in the COA Bulletin, #71, November/December 2005. Reprinted with kind permission.

Introduction
Distal radius fractures are common injuries in an orthopaedic surgical practice. Different methods for treating these fractures are available and include casting, casting with pin supplementation, percutaneous pin fixation, external fixation and open reduction and internal fixation. Treatment options vary with considerations such as fracture type, amount of displacement, patient age and level of function. In this article, we focus on the role of external fixation in the management of distal radius fractures.

Typical indications for external fixation
Indications for external fixation include: 1) distal radius fractures associated with significant soft tissue injury - to act as a tempo-rising measure, 2) intra-articular distal radius fractures with intra-articular comminution, and 3) by modifying the placement of the distal pins, extra-articular injuries or minimally displaced intra-articular injuries. Shearing injuries of the distal radius either volar or dorsal are, in general, not amenable to external fixation. If surgical treatment is indicated, they are best managed with buttress plate fixation.

Types of external fixation
External fixation of distal radius fractures is generally categorized as either "spanning" the wrist joint (Figure One), or "not spanning" the wrist joint, but spanning the fracture, commonly called "non-bridging" (Figure Two). Traditional spanning external fixation involves applying the fixator, usually from the second metacarpal to the radius proximal to the fracture site. Non-bridging, on the other hand, spans the fracture and places the pins from the proximal radius into the distal fracture fragment, usually on either side of the extensor pollicis longus tendon. Non-bridging external fixation can be used for specific types of distal radius fractures, usually an extra-articular injury (Orthopaedic Trauma Association [OTA] - type A) with at least one centimetre of bone in the distal fracture fragment and some types of complete intra-articular injuries (OTA C type) that have minimal displacement of the intra-articular component. Spanning external fixation is usually reserved for more comminuted fractures and may be augmented with kirschner wires, other schanz pins in the fracture fragment or even plates.

This abstract is a portion of the article which appears in the Winter 2007 issue of BodyCast.  
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