Neglected paediatric distal radius metaphyseal fractures treated with Joshi’s external stabilization system

Abstract

Purpose: Malunited distal radius fractures treated with internal fixation devices put the physis at risk of iatrogenic injury, while conservative treatment with a cast usually leads to loss of reduction. While the AO external fixator can be used, the radial inclination cannot be controlled during reduction. The purpose of this study was to ascertain the anatomical and functional outcome of treating malunited distal end radius fractures with Joshi’s External Stabilisation system applied as a bilateral uniplanar construct in the paediatric age group. Methods: Open reduction and external fixation with Joshi’s External Stabilisation System were performed for 4 malunited distal metaphyseal fractures of patients below 16 years. Dorsal open wedge osteotomy with bone graft was performed at the fracture site and two k-wires were passed through both cortices proximal and distal to the site of fracture and reduction was achieved with two distraction rods placed radial and ulnar to the radius bone. The external fixator was removed after the union, and the wrist was mobilised. The patients were followed up till full ROM was achieved. Anatomical outcome analysis was done using Sarmiento’s modification of Lindstrom criteria, and functional outcome analysis was done using Gartland and Werley demerit point system. Results: In our study, 4 patients underwent open reduction and external fixation using Joshi’s External Stabilisation System and all showed fracture union with no complications. The mean age of the patient was 12.25 years (Range-11-14). Meantime to osteotomy after injury was 10.25 weeks (Range-4-22). Mean QuickDASH score improved significantly from 6.25 preoperatively to 1.25 postoperatively (p=0.003). Mean Radial inclination improved significantly from 6.25 to 18 (p=0.009). Ulnar variance improved significantly from 1.75 to 0.25 (p=0.01). Palmar tilt improved significantly from 32.5 to 6.25 (p=0.001). Conclusion: Our study shows good results with fixation using Joshi’s External Stabilisation System for malunited paediatric distal metaphyseal fractures.