Treatment of Displaced Intra-Articular Fractures of the Distal End of the Radius with Plates

• Published in: Journal of bone and joint surgery. American volume 1997-09, Vol.79 (9), p.1303-12
• Main Authors: FITOUSSI, F, IP, W Y, CHOW, S P
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Bone Plates; Female; Follow-Up Studies; Fracture Fixation, Internal - adverse effects; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Radiography; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Wrist Injuries - diagnostic imaging; Wrist Injuries - surgery
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-199709000-00004

Thirty-four displaced intra-articular fractures of the distal aspect of the radius in thirty-four patients were treated with open reduction and internal fixation with plates and screws. Although there was a high rate of complications (nine [26 per cent] of thirty-four fractures), twenty-eight patients (82 per cent) had a good or excellent result according to the system of Gartland and Werley and twenty patients (59 per cent) had a good or excellent result according to the modified system of Green and OʼBrien at the most recent evaluation. Immediately postoperatively, the articular surface of the distal aspect of the radius was restored to a mean of 2 degrees of volar tilt and 20 degrees of radial angulation and radial length was improved by a mean of ten millimeters compared with the preoperative length. The articular surface was restored to congruity or to at most one millimeter of step-off in twenty-six patients (76 per cent). By the time of the most recent evaluation, the initial postoperative alignment had changed markedly in three patients (9 per cent) and degenerative osteoarthrosis (grade II or III) had developed in six patients (18 per cent). We considered that the initial postoperative alignment had changed markedly when the articular surface was displaced by two millimeters or more, when the extra-articular alignment had changed by more than 10 degrees of radial tilt, or when there was more than five millimeters of radial shortening. The potential for restoration of normal alignment and the stability of the fixation are the main advantages of internal fixation with plates. Restoration of congruity to the joint was the major difficulty in this group of patients.