An assessment of distraction plating in the management of intra-articular comminuted distal end radius fractures in the elderly patients

Abstract

Background: Distal radius fractures are one of the most common injuries representing one sixth of all fractures seen and treated in emergency department. Distal radial fractures with extensive comminution involving the metaphyseal-diaphyseal junction present a major treatment dilemma specially when it has an intra-articular involvement. This study evaluates the surgical and functional outcomes of Intra-Articular comminuted fracture of Distal End Radius treated with dorsal distraction plating. Materials and Methods: A prospective randomized controlled observational study was done with a sample size of 50 patients over a period of 3 years each of them diagnosed to be with Intra-articular Fracture of Distal End Radius (AO Classification Type C).All patients were treated by distraction plating (Radio-Metacarpal). Minimum follow up after treatment up to 6 months was ensured and final assessment of functional outcome was then decided. Results: The study showed that average union time was 8.65±0.93 weeks and average implant removal was done at 8.75±0.85 weeks. All patients achieved full ROM at wrist maintaining articular congruity post implant removal. In our study we found two (6.67%) patients with superficial infection; and two (6.67%) patients with Complex Regional Pain Syndrome (CRPS). No patients were reported with tendon (Extensor pollicis longus) irritation, neuropraxia, stiffnes of wrist and interphalangeal joints, non-union/malunion and implant failure.Conclusion:The final results were evaluated and compared after making observations for age, sex, mode of trauma, dominancy of affected hand, time interval between injury and admission, duration of hospital stay, duration of surgery, time to fracture union and complications. The final outcome was measured by DASH SCORE. All patients had excellent or good results treated with distraction plating; six (20.00%) patients out of 30 studies found to have excellent result whereas remaining Twenty four (80.00%) patients had good result.