Fracturas de radio distal tratadas con la técnica de fijación externa no puentea

"Fracturas de radio distal tratadas con la técnica de fijación externa no puenteado usando alambre-K multiplanar."

Georg Gradl MD, , Jesse B. Jupiter MD, Philip Gierer MD and Thomas Mittlmeier MD

Chirurgische Klinik und Poliklinik der Universität Rostock, Rostock, Germany; and the Hand Surgery Service and the Harvard Combined Orthopaedic Residency, Massachusetts General Hospital, and Harvard Medical School, Boston, MA

Purpose Joint-bridging external fixation is a minimally invasive treatment option for distal radius fractures. Although radial length can be restored easily the anatomic reduction of articular fragments and restoration of the normal volar tilt proves to be more difficult. A method of nonbridging hybrid fixation of distal radius fractures facilitates fracture reduction and allows for free wrist movement.

Methods Twenty-five consecutive patients with fractures of the distal radius were treated with nonbridging external fixation for 6 weeks. The stepwise surgical technique comprised a preliminary joint-bridging construction for reduction purposes, the subsequent insertion of 3 to 4 K-wires in the distal fragment, the assembling of wires to a bar nearly parallel to the fracture line, and lastly the removal of the joint-bridging part. Clinical and radiologic evaluation was performed on the first and seventh days and at 6 weeks and 2 years after surgery.

Results All fractures united. Palmar tilt (≥0°) and articular surface (articular step-off < 2 mm) were restored in all patients whereas loss of radial length occurred in 4 patients having the distal fracture fragment secured with 3 K-wires. No radial shortening was seen in fractures with 4 K-wires inserted in the distal fragment. Functional results at 2 years after surgery showed an average extension of 55° and flexion of 64° without significant differences between extra-articular and intra-articular fractures. There was no extensor tendinitis or pin loosening in the distal fragment; however, 3 pin track infections of proximal pins occurred.

Conclusions This surgical technique of nonbridging external fixation is a good treatment option for distal radius fractures: it permits wrist movement. We recommend the insertion of 4 K-wires in the distal fracture fragment.

The Journal of Hand Surgery Volume 30, Issue 5 , September 2005, Pages 960-968.

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