Open Reduction And Internal Fixation For The Unstable Fracture Of The Distal Radius In Adult

Distal radius fracture is one of the most common fractures, the incidence of whichapproximates17%in emergency patients. High frequent activities of the wrist jointmake full functional recovery of joints very important.Improper treatment easily leadsto wrist stiffness and chronic pain and seriously affects the function of hand, so goodfracture reduction and fixation becomes the key of treatment. For the unstable distalradius fracture, selecting the most appropriate treatment method to obtain the bestoutcome has become one of the many clinicians’ problems. In recent years, a lot ofstudies in the literature reported the use of different implants and operation techniquesto improve the recovery of wrist function. At present, the application of lockingcompression plate (LCP) by open reduction and internal fixation method has becomethe preferred treatment of unstable fracture of the distal radius. Our department used thelocking compression plate for the unstable fracture of the distal radius in adult and alsoachieved satisfactory curative result.Objective: We evaluated the application of locking compression plate in openreduction and internal fixation for the unstable distal radius fractures.Methods: From2009January to2011January in our department,48cases with50sides of unstable distal radius fractures have been treated by the application oflocking compression plate in open reduction and internal fixation.16cases were maleand32female. The mean age is57.4years (24to76years old). Fractures on left sideoccurred in19cases and right side31cases. The interval from injury to operationaverages4.3D (1~14d). According to AO classification, type A3occurred in4cases,B1in5cases, B2in7cases, B3in7cases, C1in8cases, C2in10cases, and C3in9cases.45sides in43cases were treated with palmar approach and5sides with dorsalapproach.3cases involves median nerve injury.30cases had styloid process of ulna fracture and3cases has dislocation of distal radioulnar joint. The internal materials forfixation all adopt the locking compression plates (LCP). Improvements of wrist jointactivities after operation, X-ray measurement of volar tilt, radial inclination, radialshortening, articular surface steps and12months postoperative wrist Gartland-Werleyfunctional score are applied to evaluate its curative result.Results: The follow-up time lasted12~24months with a mean of12.3months.All patients have reached bony healing with healing time of9(8~13) weeks onaverage. According to X-ray measurement indexes preoperative, postoperative,1month,3months,6months after operation and12months postoperatively, all patientswith palmar tilt, radial inclination, articular surface level significantly improved afterthe operation and radial shortening was recovered. At the12-month follow-up, activitiesof the wrist joints achieved an average of65degrees palmar flexion,75degreesextension,35degrees ulnar deviation, radial deviation of26degrees,85degreespronation, supination of83degrees and the average recovery of grip strength comes tothe contra lateral95%. The wrist joint function was excellent in26cases, good in18cases, moderate in6cases; the excellent and good rate was88%. One case with thefracture of type C2experienced slight shift at2weeks after operation, whose fracturehealing with a mild deformity and a little functional limitation.2cases experiencedpostoperative reflex sympathetic dystrophy, which were apparently relived by stellateganglion block. The incision scar pain occurred in1case that was cured by localblockade.Conclusion: For unstable distal radius fractures, application of lockingcompression plate in open reduction and fixation supplemented with scientifically andregularly functional exercise can obtain good clinical result and less operationcomplications.