Treatment of distal radius fractures with dorsal dislocation of Fernandez type IV by open reduction and internal fixation

Abstract

Objective To report the treatment of distal radius fractures with dorsal dislocation of Fernandez type Ⅳ by open reduction and internal fixation via a combined dorsal and volar approach. Methods A retrospective analysis was conducted of the 14 cases of fresh distal radius fracture with dorsal dislocation of Fernandez type Ⅳ which had been treated by open reduction and internal fixation via a combined dorsal and volar approach at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from July 2010 to June 2016. All the patients were male, with an average age of 38.4 years (from 27 to 52 years). The time from injury to surgery averaged 6.9 days (from 4 to 10 days). Their injury involved 5 left and 9 right wrists. Follow-up was performed at 1, 2, 3, 6 and 12 months after operation when anteroposterior and lateral X-ray films were taken and functional exercise guidance was provided. At 6 and 12 months after operation, all the patients were evaluated using modified Garland-Werley scoring and Patient Rated Wrist Evaluation (PRWE). Results The patients were followed up for an average of 19.4 months (from 15 to 26 months). Their fractures healed well. Their fracture healing time averaged 3.1 months (from 2 to 4 months). Their modified Garland-Werley scores at 6 and 12 months after surgery were 8.9 points (from 6 to 13 points) and 7.3 points (from 4 to 11 points), respectively; their PRWE scores were 17.9 points (from 12 to 25 points) and 16.5 points (from 11 to 23 points), respectively. None of the patients was inflicted by infection, vascular injury or internal fixation failure. Conclusion The open reduction and internal fixation via a combined dorsal and volar approach can restore the stability of both the dorsal osseous structure of the distal radius and the volar ligament structure of the wrist, facilitating postoperative maintenance of the radiocarpal joint stability, improving the wrist function and leading to satisfactory outcomes. Key words: Radius fractures; Fracture fixation, internal; Ligaments; Surgical approach