Arch Hand Microsurg.  2018 Sep;23(3):166-174. 10.12790/ahm.2018.23.3.166.

Functional Outcome of the Wrist according to Degree of Distraction with External Fixation in the Treatment of Distal Radius Fracture

• Roh TH
• Jeon YM
• Na Y
• Lee TJ

• KMID: 2419451
• DOI: http://doi.org/10.12790/ahm.2018.23.3.166

Abstract

PURPOSE
This study aimed to evaluate the relation between the degree of wrist joint distraction and postoperative restoration of joint function after performed external fixation with distraction of wrist joint in distal radius fracture.
METHODS
This study was conducted retrospectively on 55 patients who underwent reduction using external fixation for distal intra-articular radius fracture from January 2007 to December 2014. The degree of pre- and post-operative distraction was measured radiographically using the carpal height ratio (CHR). For postoperative functional assessment, range of motion of the wrist, Gartland Werley classification, grip strength, and pinch strength were measured.
RESULTS
In the functional assessment based on the Gartland Werley classification, excellent was reported by 31 patients, good; 16 patients, fair; 8 patients, and poor; 0 patients. The mean CHR was 0.519 preoperatively and 0.565 immediately after surgery. The mean postoperative CHR of excellent group was 0.581, demonstrating better clinical outcome in distraction than other groups. Eight case of joint stiffness was manifested when CHR value was lower than 0.54 and only 1 case of joint stiffness was manifested when CHR value was higher than 0.54, showing a tendency for lower incidence of joint stiffness when distracted over 0.54 of CHR.
CONCLUSION
External fixation after sufficient distraction of the wrist joint produced an excellent outcome in the functional assessment. The better the prognosis in the Gartland Werley classification, the higher the CHR and the group with a CHR greater than 0.54 immediately after surgery showed less joint stiffness than the lower group.

Keyword

Radius fractures; External fixators; Distraction

MeSH Terms

Classification
External Fixators
Hand Strength
Humans
Incidence
Joints
Pinch Strength
Prognosis
Radius Fractures*
Radius*
Range of Motion, Articular
Retrospective Studies
Wrist Joint
Wrist*

Figure

• 

  Fig. 1 Carpal height ratio: dividing the distance from the distal radius and the base of the 3rd metacarpal A to the length of the 3rd metacarpal B.

• 

  Fig. 2 (A) Distal radius volar tilt: the angle between a line along the distal radial articular surface and the line perpendicular to the longitudinal axis of the radius at the joint margin (normal range, 2°–20°). (B) Radial inclination: the angle between one line connecting the radial styloid tip and the ulnar aspect of the distal radius and a second line perpendicular to the longitudinal axis of the radius (average, 23°). (C) Radial height: the distance between two parallel lines drawn perpendicular to the long axis of the radial shaft, one from the tip of the radial styloid and the other from the ulnar corner of the lunate fossa (average, 12 mm).

• 

  Fig. 3 (A) The intraoperative X-ray of an intra-articular distal radius fracture. Preoperative CHR was 0.52. (B) The intraoperative X-ray of an intra-articular distal radius fracture after performed closed reduction by distraction. (C) The intraoperative X-ray of an intra-articular distal radius fracture after applied with external fixator. (D) The postoperative posterior-anterior X-ray of an intra-articular distal radius fracture treated with external fixation. Postoperative CHR was 0.57 and increased about 10%. CHR: carpal height ratio.

• 

  Fig. 4 The CHR was increased by 11% postoperatively, and the carpal height ratio decreased with time. The CHR was the most decreased after 2 weeks of the external fixation. (A) Preoperative X-ray. CHR=0.52. (B) Postoperative X-ray. CHR=0.58. (C) POD 2 weeks. CHR=0.54. (D) POD 4 weeks. CHR=0.53. (E) POD 6 weeks. CHR=0.52. (F) After external fixation removal. CHR=0.51. CHR: carpal height ratio, POD: postoperative day.

• 

  Fig. 5 A 46-year-old female patient was admitted to the hospital with slip down. (A) The posterior-anterior X-ray of an intra-articular distal radius fracture. Preoperative CHR was 0.53. (B) The posterior-anterior X-ray of an intra-articular distal radius fracture treated with spanning external fixation. Postoperative CHR in this case was 0.59 and increased about 11%. CHR: carpal height ratio.

• 

  Fig. 6 A 58-year-old male patient was admitted to the hospital with 2-m-high fall down. (A) The posterior-anterior X-ray of an intra-articular distal radius fracture. Preoperative CHR was 0.57. (B) The posterior-anterior X-ray of an intra-articular distal radius fracture treated with spanning external fixation. Postoperative CHR in this case was 0.52 and increased about 9%. CHR: carpal height ratio.

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