Objectives

Fractures of the distal end of radius are the most frequently occurring upper skeletal injuries managed by orthopaedic surgeons.The incidence of complications after surgical treatment still remains high. The objective of our study was to assess functional and radiological results of DRF.

Methods:

Retrospetive study of   55 patients of distal end radius fractures were treated with percutaneous pinning, external fixation and volar locking plate fixation. CASTAING classification was used. Functional outcomes were assessed using Demerit Point System of Gartland and Werley (modified). 

Results:

Excellent to good results were obtained in most fractures treated by open reduction and internal fixation with volar plate and KAPANDJI pinning.Reduction was well-maintained, complications were less and functional parameters showed a significant improvement during the follow-up period

Fractures of the distal radius are a common clinical problem affecting skeletally mature people. [1] The young sustain this injury as a result of significant local trauma. The elderly have predisposing risks of disuse or postmenopausal osteoporosis[2].The most common trauma mechanism is a fall onto the hand, in hyperextension. Classification systems have been developed with the aim of allowing surgeons to classify fractures into different and clinically useful groupings[3].The final choice of treatment method will be influenced by many considerations including the nature of the fracture, bone stock and fragility, the presence of local complications (compound injury and nerve injury) or other injuries, the patient’s general medical condition, the expected functional loading (activity demands),[4] and patient motivation. In our study, we have included closed reduction with plaster cast; percutaneous pinning; external fixation with external fixator using the principle of ligamentotaxis; and internal fixation with plates, pins, and screws, depending on the type of fracture and patients general condition

The aims are as follows:

1. To study the outcomes different treatment modalities of fractures of distal end of radius
2. To study the complications of different treatment modalities

Guidelines for acceptable closed reduction as given by [5] include: Radial inclination; Radial length; Radial Tilt; Articular incongruity                                                 

Figure 1: wrist X-Rays percutaneous pinning

Figure-2: Wrist X-Rays : Volar plate

This prospective study was conducted over a period from Janvier 2016 to December 2018 and the detailed analysis of different modalities of treatment of fractures of the distal end radius was carried out. On arrival of patient, detail history regarding age, sex, mode of injury, days since injury, associated injuries were noted carefully. The patients were assessed clinically and radiologically. The fracture pattern was noted and the fractures were classified according to CASTAING classification system. Radiological assessment was done in terms residual dorsal tilt, radial shortening and loss of radial inclination and the results were graded according to of Lindstrom criteria modified:

Functional evaluation of the patients was done at last follow-up according to the demerit point system of Gartland and Werley

Oservations and results:

In our study of 55 patients, 40 were males and 15 were females. The fractures were most common among 21–40 and 41–60 years of age group. The youngest patient was 18 years old and the eldest was 68 years old.The most 

common fracture in our study, according to CASTAING classification was colles followed by  fractures with volar displacement

Anatomical Evaluation:

Anatomical evaluation results according to Sarmiento’s modification of Lindstrom criteria were obtained

In our study, assessment of functional outcome by Demerit’s Point System of Gartland and Werley with Sarmiento et al. modification revealed excellent results with open reduction and plate fixation and percutaneous pinning modalitIES (80%), followed by ligamentotaxis by external fixator application (66%) 

Complications

The most common complications encountered in our series were stiffness and pain in the wrist joint after removal of  external fixator because of lack of wrist movements for prolonged time. We observed Plaster sores in two patients, pin tract infections in five patients, which were superficial and got treated by oral antibiotics. The presence of deformity in one patients

The fractures of the distal end of radius despite being the commonest upper extremity fractures continue to pose a therapeutic challenge.  In this study the open reduction and internal fixation with plate and screws and  percutaneous pinning gave a restored radiological outcome compared to the ligamentotaxis   but the functional outcome remained the same in all the three treatment groups.