J Korean Fract Soc.  2018 Jan;31(1):1-8. 10.12671/jkfs.2018.31.1.1.

Anatomical Reduction with Brick-Work Technique in Comminuted Intraarticular Distal Radius Fractures

• Kim HM
• Cho HL
• Chae JW
• Shin MJ

• KMID: 2402708
• DOI: http://doi.org/10.12671/jkfs.2018.31.1.1

Abstract

PURPOSE
This study examined the clinical outcomes of comminuted intraarticular distal radius fractures treated by an anatomical reduction using a brick-work technique.
MATERIALS AND METHODS
Seventeen patients with AO/OTA type 23-C3 distal radius fractures were enrolled in this study. An anatomical reduction of the articular surface was achieved using a brick-work technique through the dorsal approach and dorsal plates were used for fixation. The postoperative functional results were assessed with the range of motion of the wrist and the modified Mayo wrist score (MMWS). In addition, the radial length, radial inclination, volar tilt, and Lidstrom score were evaluated from the radiology results. The mean postoperative follow-up period was 13.6 months.
RESULTS
All patients showed bony union and the mean range of motion of the injured wrists was 94% (92% to 95%) of the uninjured side. The mean MMWS was 85.3, and the functional results were excellent in 12 patients, good in 4, and fair in one at the final follow-up. Based on the final radiographic measurements, the radial length, volar tilt, and radial inclination were 11.4 mm (10.0 to 13.5 mm), 6.6° (−1.8° to 9.2°), and 21.3° (20.1° to 25.7°), respectively. The radiologic results according to the Lidstrom score were excellent in 14 patients and good in three.
CONCLUSION
An anatomical reduction with the brick-work technique is relatively easy, results in a reproducible clinical outcome, and could be a safe and effective treatment option for severe comminuted intraarticular distal radius fractures that are not amenable to volar plate fixation.

Keyword

Distal radius fracture; Dorsal approach; Intraarticular comminution

MeSH Terms

Follow-Up Studies
Humans
Radius Fractures*
Radius*
Range of Motion, Articular
Wrist

Figure

• 

  Fig. 1 Schematic diagram of the dorsal plating with brick-work technique. (A) Displaced intraarticular fracture with multi-fragmentary central and dorsal comminution. (B) After elevating the dorsal comminuted fragments, the articular surface was reduced from the volar to dorsal sequence and provisional fixation with a temporary K-wire. (C) Dorsal comminuted fragments were reduced in its original position. (D) Final application of dorsal contoured plate and screws.

• 

  Fig. 2 Case of a 74-year-old male with an intraarticular distal radius fracture. Posteroanterior and lateral radiographs (A), and computed tomography images (B) show central and dorsal multi-fragmentary comminution corresponding to an AO/OTA 23-C3 fracture pattern. (C) Postoperative follow-up radiographs after 6 months show complete union.

• 

  Fig. 3 Intraoperative images of dorsal plating with brick-work technique reduction. (A) The dorsal fragment was elevated for the reduction of displaced volar articular fragments. (B) The articular surface was reduced using periosteal elevator. (C) The plate was fixed using a locking screw. (D) Extensor retinacular sling for the protection of the extensor pollicis longus tendon.

• 

  Fig. 4 Case of a 31-year-old male with an intraarticular distal radius fracture with dorsal comminution. Posteroanterior and lateral radiographs (A), and three dimensional reconstructed computed tomography images (B) show dorsally displaced comminuted fragments. (C) Postoperative followup radiographs after 5 months show complete union and maintained radiographic parameters. (D) Final follow-up radiographs after removing the implants at 11 months after surgery.

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