Abstract
Introduction:The aim of this study was to evaluate the clinical outcomes following treatment of distal radial fractures using intramedullary elastic wires with a combination of either cast immobilisation or external fixation.Materials and methods:A total of 42 patients (24 females and 18 males) aged 40 to 78 years who presented with displaced and unstable, closed or grade I open, extra- and/or intra-articular fractures of the distal radius were included in the study. Twenty-seven fractures were AO/OTA Type A2-A3 and 15 Type C1-C2. Twenty-four patients were treated with antegrade intramedullary (IM) fixation with elastic wires followed by cast immobilisation and 18 required an external fixator in lieu of casting.Results:Final follow-up evaluation was conducted 12 months post-surgery using Sarmiento's modification of Lindstrom criteria and the demerit point system of Gartland and Werley. Successful fracture union was observed in all patients between eight to 14 weeks. Using Sarmiento's modification of Lindstrom criteria, 12 patients (28.6%) had excellent, 23 (54.8%) had good and 7 (16.6 %) had fair results. Based on the functional evaluation using the demerit point system of Gartland and Werley, 13 patients (31%) had excellent, 25 (59.5%) had good and four (9.5%) had fair results. None of the patients had a poor outcome using either of these criteria. Although a fracture union rate of 100% was confirmed clinically and radiographically, eight out of the 42 patients had minor complications in our study. One patient had uneventful IM migration of the wires, one patient reported a feeling of wire loosening, three patients complained of joint stiffness and soft tissue irritation, and three others reported on-going pain. The total cost of all implants used per case was less than INR 1,000.Conclusions:Good to excellent functional and radiographic outcomes with easy to manage complications are achieved with the techniques described. Patient selection is key to determining which particular method should be prescribed in a given case.
Highlights
The aim of this study was to evaluate the clinical outcomes following treatment of distal radial fractures using intramedullary elastic wires with a combination of either cast immobilisation or external fixation
Successful fracture union was observed in all 42 patients with average time to fracture union of 10.8 weeks
In a prospective, randomised trial by McQueen et al, a total of 120 patients were divided into four equal groups of 30 patients each, who received one of four treatments: (i) closed re-reduction with a forearm cast for six weeks, (ii) open reduction with bone grafting and K-wire fixation with a forearm cast for six weeks, (iii) closed rereduction with external fixation in which pins were inserted into the bone by an open technique, axis of wrist was locked for six weeks and the fixation was removed after six weeks, and (iv) same as (iii) but axis of the wrist was locked only for three weeks[20]
Summary
The aim of this study was to evaluate the clinical outcomes following treatment of distal radial fractures using intramedullary elastic wires with a combination of either cast immobilisation or external fixation. Soft tissue irritation, algodystrophy, pin tract infection, injury to radial sensory nerves and extensor tendons with this technique continue to be reported in the literature[10,11] Another option for such fractures is an intramedullary (IM) nail with supplementary screw fixation. This minimally invasive implant can result in reduced implant irritation, lower post-operative pain, and provides a strong and stable fixation enabling early range of motion exercises at the wrist joint. These too are fraught with complications such as injury to the superficial branch of the radial nerve, screw penetration into the distal radio-ulnar joint, and potential loss of reduction[12]
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