ASSOCIATED INJURIES
Distal Radioulnar Joint - Ulnar styloid fracture - frequent -
rarely unstable - usually partial TFCC tear - rarely needs treatment
- Disruption
- Diastasis - Complete TFCC tear
- Bony constraints cannot control
- Requires soft tissue stabilization
- Repair with sutures/suture anchors
- ORIF larger fragments
- Ulnar Head/Neck Fracture - Comminuted - very unstable
- Difficult to securely fix
- Treat with excision/soft tissue reconstruction
- Bone can be used for grafting radius
Median Nerve Injury
- Contusion
- Hematoma/Compression
- Traction/Neuropraxia
Reduction process frequently increases intracompartmental pressure
in carpal canal
- Early surgical decompression recommended if significant symptoms
- Late decompression - less successful
Scaphoid Fracture
- Look for
- If nondisplaced - percutaneous pin fixation
- If displaced - ORIF
- Be careful not to over-distract
Intercarpal Ligament Injury - Total/Partial
- Scapholunate - Common
- Lunotriquetral - Common
- Can see diastasis in traction x-ray
- Treated early with percutaneous pin fixation - usually adequate
- Don't over-distract
- Pearls - look for - treat adequately.
- Pitfalls - failure to diagnose +/or adequately treat
References
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Internal Fixation and Early Motion
Jesse B. Jupiter, MD
"Intelligence is the ablility to inhibit fixed actions"
Sir Charles Sherington, 1930
- Hypothesis - Anatomy does correlate with function!
- Distal radius. Foundation of two joints.
- Radiocarpal- radial alignment.
Important for normal carpal kinematics.
- critical capsular ligaments originate from radius
- intercarpal ligament injuries shown to be commonplace
- ASSS- axial scaphoid shift sign - scaphoid more distal than lunate
with traction suggests S-L ligament injury.
- Carpal instability post-fracture more commonplace than previously
thought
- Distal radioulnar joint. Sigmoid notch is a critical part.
- Distal radioulnar joint involvement can be categorized into 3 basic
groups.
- Stable - avulsion fracture styloid or stable neck fracture.
- Unstable - subcutaneous TFCC or avulsion fracture base of the styloid
- Potentially unstable Intraarticular fracture sigmoid notch or
intraarticular fracture of ulnar head.
- Fracture Classifications Relative to Operative Indications
- Bending fractures (AO Type A) - When associated with neurologic
deficit or seen late.
- Shearing fractures (AO Type B) - definite indication
- Compression fractures (AO Type C) - 4 part fracture with displaced
volar lunate facet.
- Radicarpal fracture-dislocation - frequent.
- Comminuted complex fracture - common.
- Algorithm
- Shearing Fracture (AO Type B)
- Volar (AO Group B3). Vast majority will be split into two or more
fragments (Jupiter et al, Journal of Bone and Joint Surg, 78A: 1996.)
- Operative Approaches - Simple
- Operative Tactics - buttress plate
- Post-operative Management
- Splint for two weeks, then active assisted range of motion
- Results favorable: 31 excellent 10 good, 8 fair (Jupiter et al.,
JBJS, 78A: 1996.)
- Dorsal (AO Group B2)
- Uncommon
- More open combination with styloid
- Operative approach
- Operative tactics: Plate fixation; p plate very effective.
- Post-operative management ? to volar
- Radial Styloid (AO Group B1)
- Association with scapholunate ligament injury
- Styloid often in 2 or more fragments
- Operative approach
- Fixation with cannulated screws
- Post-operative managment dependent upon ligaments
- Compression Fractures
- Many 3-part fractures can be treated with percutaneous pins and
external fixation.
- 4-part frature may need volar exposure (Melone Type IV)
- Operative tactics
- reduce and percutaneously fix volar lunate facet with plate or K-wire
- Volar ulnar approach and reduce and fix volar lunate facet with plate or K-wire
- Manipulate and fix dorsal lunate facet with K-wire.
- External fixation is usually necessary.
- Radiocarpal Fracture-Dislocation
- Open high energy trauma
- May have intracarpal ligament injury
- Ulnar styloid fracture often needs fixation
- Complex Combined Fractures
- Ipsilateral skeletal and ligament injury
- Associated complex carpal trauma
- Proximal skeletal and articular injury
- Fractures with bone loss
- Fractures with neurovascular injury
- Compartment syndrome
- Failure of Prior Treatment
- "Nascent Malunion"
- Operative treatment may limit overall disability
- Applicable, even in an elderly patient
The Role of Arthroscopic-Assisted Fixation
William B. Geissler, M.D.
Associate Professor
Division of Hand and Upper Extremity
Department of Orthopaedic Surgery
University of Mississippi Medical Center
Jackson, Mississippi
Distal Radium Factures
- Estimated 1/6 of fractures seen in the Emergency Room
- Majority of these injuries treated by closed reduction/casting
Displaced Intraarticular Fractures
- Specific subset of distal radius fractures
- High energy injury resulting in comminuted fracture pattern
- Usually occurs in younger age population
- Inherent tendency for shortening and collapse
- Associated with carpal and distal radioulnar instability
- Less amenable to closed manipulation and casting
Arthroscopic Assisted Reduction
- Advantages
- Ideal view of joint surface with minimal surgical trauma
- Joint surface viewed under magnification and ample light
- Osteochondral flaps, loose bodies may be excised
- Associated soft tissue injuries detected and managed
- Evaluate ulnar styloid fragment
- Disadvantages
- Technical procedure
- Learning curve
- Special equipment helpful
Surgical Technique
- Arthroscope --- 3-4 portal
- Working portal --- 4-5 portal or 6-R portal
- Inflow --- 6-R portal
- Usually easier to triangulate from 4-5 portal if fibrin clot/debris
obscures vision
- Easier to elevate fragment with instruments from 4-5 portal
- Compressive elastic wrap around forearm - retard fluid extravasation
Instrumentation
- Small joint arthroscope (2.7 mm)
- Traction tower
- Motorized shaver
- Fluoroscopy unit
- Traction tower allows manipulation of wrist to help reduce fragments
while maintaining traction
Inflow Portal
- Very important to have separate inflow/outflow access
- Helps retard fluid extravasation
- Gravity irrigation through scope cannula usually not adequate
- Gravity irrigation through 6-U portal, outflow through scope
provides adequate flow
- Mechanical pump optional, may be used through scope, separate
outflow portal
- Tourniquet helpful, controls troublesome bleeding which obscures
vision
TIP: Be patient. Thoroughly irrigate the joint of fibrin clot and debris to improve visualization.
Landmarks
- These wrist are very swollen, unable to palpate usual soft tissue
landmarks
- Know bony landmarks; metacarpal bases, dorsal lip of radius, ulnar
head usually palpable
- Radial side of long finger, mid axis of ring finger used to determine
radioulnar location of 3-4 and 4-5 portals
Timing of Reduction
- Between 3 to 7 days
- Earlier attempts may have troublesome bleeding, obscure vision, fluid
extravasation?
- Later attempts harder to disengage and mobilize fragments
| Intracarpal Soft Tissue Injuries |
|
Patients |
TFCC |
S-L |
L-T |
Chondral |
Geissler, et al
JBJS 1996 |
60 |
49% |
32% |
15% |
- |
Hanker
AANA 1993 |
65 |
55% |
75% |
- |
30% |
Lindau, et al
JHS-B, 1997 |
50 |
78% |
54% |
16% |
32% |
Arthroscopic Classification of Carpal
Interossus Ligament Tears |
| Grade |
Description |
Management |
| I |
Attenuation/hemorrhage of interosseous ligament as
seen from the radiocarpal joint. No incongruency of carpal alignment
in the midcarpal space. |
Immobilization |
| II |
Attenuation/hemorrhage of interosseous ligament as
seen from the radiocarpal joint. Incongruency/step-off as seen
from the midcarpal space. A slight gap (less than width of a probe) between
carpals may be present. |
Arthroscopic/reduction and pinning |
| III |
Incongruency/step-off of carpal alignment is seen in
both the radiocarpal and midcarpal space. The probe may be passed through gap
between carpals. |
Arthroscopic/open reduction and pinning |
| IV |
Incongruency/step-off of carpal alignment is seen in
both the radiocarpal and midcarpal space. Gross instability with manipulation
is noted. A 2.7 mm arthroscope may be passed through the gap between carpals. |
Open reduction and repair. |
Indications
- Displaced intraarticular fracture with articular cartilage step-off
of 2 mm or more after closed manipulation
- Intraarticular or extraarticular fracture with suspected carpal
ligamentous injury or distal radioulnar instability
| Arthroscopic Assisted Reduction |
|
|
|
Gartland & Werley |
|
Patients |
Articular Reduction < 1 mm |
Excellent |
Good |
Fair |
Geissler, Freeland
CORR, 1996 |
33 |
All |
20 |
10 |
3 |
Wolfe
Arthroscopy, 1995 |
7 |
All |
6 |
1 |
- |
| Arthroscopic V. Open Resuction |
| Matched Cohorts: 12 ATS v. 12 open |
|
Excellent |
Good |
Fair |
| Arthroscopic |
5 |
6 |
1 |
| Open |
- |
10 |
2 |
CONTRAINDICATIONS
- Compartment syndrome
- Open joint with massive soft tissue injury
RADIAL STYLOID FRACTURES
- Can almost always be reduced anatomically
- In complex fracture patterns provides anatomic landmark to reduce
remaining fragments
- Radial styloid fragment may be manipulated and pinned under
fluoroscopy and reduction "fined tuned" as viewed
arthroscopically
- Alternatively, 2 Kirschner wires may be placed and used and joysticks
to manipulate and reduce the fragment as seen arthroscopically
KIRSCHNER WIRE PLACEMENT
- Stay dorsal in snuffbox so as not to impale radial artery
- Protect cutaneous nerves
- Place 0.045 Kirschner wires through 14-gauge needle
TIP: Place needle cap over exposed wires.
THREE PART FRACTURES
- Reduce radial styloid as before
- Medial fragment can be manipulated up with joysticks
- Place needle intraarticularly over displaced fragment to be elevated
- Helps determine location of the fragment to be reduced
- Drop down 1-2 cm proximally in line with needle and place Steinmann
joystick into fragment to elevate it
- Sagittal gap may be closed with large bone tenaculum placed on radial
styloid and medial fragment
- Alternatively, blunt trocar through 4-5 portal disimpact and elevate,
useful for impacted fragments in lunate fossa
- Pin transversely just beneath subchondral bone, aiming dorsal ulnar
to catch "die- punch" fragment
TIP: Pronate/supinate wrist to make sure transverse pins do not violate
radioulnar joint.
FOUR PART FRACTURES:
- Reduce redial styloid fragment as before
- Limited open reduction, approach volar medial fragment between ulnar
neurovascular bundle and flexor tendons and buttress plate
- Volar fragment now used as fulcrum to arthroscopically reduce
remaining dorsal fragments like a "die punch" fracture
VOLAR AND DORSAL BARTON'S FRACTURE
- Plate as classically described
- Percutaneous pinning does not provide sufficient stability
- Do not sacrifice stability for an arthroscopic procedure
- Arthroscopically evaluate joint through standard portals after
plating
- Alternatively place scope ulnar to long radiolunate ligament after
plating of volar Barton's fracture as described by Levy and Glickel
ULNAR STYLOID FRAGMENT
- Arthroscopic evaluation provides rationale for management
- Palpate the TFCC, should be taut
- Taut TFCC, majority of TFCC fibers still attached to proximal ulna
- Lax TFCC, look for peripheral TFCC tear, repair if present, consider
ORIF ulnar styloid fragment if peripheral tear is not present
MID CARPAL SPACE
- Best location to evaluate for carpal instability
- Possible traumatic loose bodies (hamate)
EXTERNAL FIXATION
- Consider when metaphyseal comminution is present
- May be placed before or after arthroscopic reduction
- If before, external fixator is used to reduce the fracture and the
fracture is "fine tuned" arthroscopically
- If after, surgeon is not laboring around bulky frame
- Bone graft added through small incision between fourth and fifth
dorsal compartments
TIP: Medial fragments may be further stabilized with treaded half pin
through free clamp and attached to frame.
PROGNOSIS
- Radial shortening
- Angulation
- Articular reduction (radioulnar)
- Associated soft tissue injuries
ARTICULAR CONGRUITY
- 2 mm of articular displacement
Knirk, JL; Jupiter, JB: J Bone Joint
Surg, 68A:647-689, 1986.
Bradway, J; Amadio, P; Cooney, W: J Bone Joint Surg, 71A:839, 1989.
- 1 mm of articular displacement
Fernandez, DL; Geissler, WB: J Hand Surg, 16A:375-382, 1991.
Trumble, T; Schmitt, S; Vedder, N: J Hand Surg 19A:325-340, 1994.
SOFT TISSUE INJURIES
- Arthrogram studies
- Hixon: 82% positive wrist arthrograms, 22 patients with distal radius
fractures
- Variety of isolated and combined tears
- Radiographs evidence of carpal instability 41%
|
TFCC Tears |
Patients |
| Fontes, Ann Chir Main: 11:119, 1994 |
66% |
58 |
| Mohanti, In jury 11:311, 1979 |
45% |
60 |
ARTHROSCOPIC STUDIES
Geissler, et al.- JBJS, 1996
RESULTS
Stewart, et al. - AAHS, Scottsdale, AZ - 1998
THE ROLES OF THE DRUJ AND REHABILITATION IN OUTCOME OF DISTAL
RADIUS FRACTURES
Matthew D. Putnam, M.D.
Minnesota Hand, Department of Orthopaedics, University of Minnesota
- Purpose:
- Introduce the DRUJ as a key factor in determining outcome of distal radius fractures.
- Provide a suggested outline for triage.
- Introduce rehabilitation as an issue related to fixation "strength" and with variable efficacy.
- Provide a checklist of rehabilitation concerns.
- Provide a reference list.
- Introduction:
- Abraham Colles, M.D.
- Chair of Surgery at the Royal College of Surgeons in Dublin
- Published extensively on venereal disease
- On the Fracture of the Carpal of the Extremity
Of the Radius, Edinb. Med Surg. J, 10:181, 1814.
- "...in the treatment of this fracture, our attention should be
principally directed to guard against the carpal end of the radius being
drawn backwards."
"...the limb at some remote period again enjoy perfect freedom in all
its' motions and be completely exempt from pain."
Abraham Colles, 1843
- A useful question might be did all of Colle's patients do well
at "some remote time"?
What was different?
Demographics
Expectations
- Demographics:
Active, older adults
- Study at Malmö Sweden over a five year period
- 1953-57 urban population of 200,000
- 2000 distal radius fractures (20/10,000)
- 74.5% of all forearm fractures
- Greatest frequency in 6 to 10 years old and 60 to 69 years old
- Repeat study in Malmö, Sweden
- Same population 25 years later
- During 1980 and 1981
- Age specific incidence almost doubled
Prospective Study (1998) Bergen Norway
- 609 distal radius fractures (38/10,000)
- 79% occurred in women
- Most frequent in 60 to 69 years old
- What are patient's expectations?
- Painless use of wrist and forearm
- Reasonable ROM of wrist
- Unrestricted supination and pronation
- No new sequelae
- Rapid recovery
- Predictable recovery
- How are we doing?
- 100 patients treated by casting
- 85% of 10 year survivors has satisfactory function (Warwick)
Is this good enough?
15% not satisfactory in Warwick series
20-60% not satisfactory in "complex" series
- Assume malunion is an issue.-What is majunited?
Radio Carpal
Unlar Column
What was Darrach Thinking?
- The DRUJ/Ulnar Head
- Point of attachment TFCC
- Direct longitudinal load transmission
- Sloppy hinge/rolling joint Shape constraint variants
- Resist transverse compressive forces
- Requires relaxation of PQ to supinate
- Points of Attachment and Function TFCC
- Displacement of dorsal band increases with pronation
- Displacement of dorsal palmar band increases with supination
(Acosta)
- Shape Analysis of DRUJ
A second method of evaluating Type I, II and III is to describe
"The Ulnar Seat." In 100 wrists, all but one wrist had a
positive ulnar seat-regardless of ulnar variance.(Sagerman)
- Why Study This?
- Because this presenter contends that forearm rotation abnormalities
are a frequent source of patient dissatisfaction.
- Specifically, our most recent group of 66 patients treated for distal
radius fractures, included 30 malunions. Greater than 50% of these patients
complained primarily of
- pain with FOREARM rotation.
- Several studies have looked at effect of varying wrist stiffness on
function. In fact Weiss, et al, reports 64% task completion rate for fused
wrist vs. 78% rate for normal wrist.
- But no study has compared one bone forearm to wrist fusion to normal.
- What is Proposed?
- Rethinking classification scheme:
- Fracture Non-Displaced
Fracture Displaced:
- Non-functional angular joint change
- Functional angular joint change
- Non Functional joint surface change
- Functional joint surface change
- Fracture Combinations:
- Modifiers:
- Soft tissue injury
- Ulnar styloid injury
Case Examples:
- Post External fixator DRUJ instability. (Riebe)
- MRI evaluation may have yielded more information.
- Post ORIF Mal splinting "tightened" pronator quadratus and volar
TFCC. (Brekola)
- Unstable Fracture (Extra Articular)
WIth DRUJ angular joint change
Rehabilitation
- It is this authors opinion that this subject has had little attention
devoted to it, with minimal scientific focus.
- General Focus:
Pain Management
Regaining Motion
Regaining Strength and Function
- A general contention is that early motion after fracture in or near a
joint is beneficial to the patient.
- Aside from scientific studies performed on rabbits, multiple authors
offer anecdotal support for this concept. (Thompson, Wehbe)
- Additionally, the suggestion has been made that good pain control
facilitates motion facilitates pain control. (Miller)
- Some newer therapies have also been attempted with limited success.
- Low frequency ultrasound has not been shown to increase mobility.
(Basso)
- But excepting instruction, visits to therapists themselves may not
offer functional advantages. (Oskarsson)
- Moreover, at least one clinical author has identified the issue of
risks of early motion related to strength of fixation. (Margles)
- Specifically, we have looked at simulated gripping activities in our
lab and found that light grip (5-10 pounds) is capable of delivering a 300
newton force to the distal radial metaphyses. (Meyer et al.)
- Comparison of wrist and forearm splints
- Thus regardless of rehabilitation preference, the first question
before beginning any program is how stable is my patients fracture
fixation?
- Some comparative examples exist. All are cadaveric tests.
- My Point ls
Plan Fixation to Equal Rehabilitation Plan
- Rehabilitation Tricks:
- Maintenance of supination
- DRUJ Stabilization
- Stretches pronator quadratus
- Emphasis by Sarmiento
- Understand failure points and load transfer mechanism of any fixation
employed.
- Present athletes with strength target before allowing them to return
to competition.
- Review patient progress in the first 72 hours and emphasize AAROM,
x-ray.
- Change to removable splint at 3 weeks, if x-ray stable & swelling
down.
- Start AAROM of forearm and light AROM of wrist out of splint.
- Pins out in office at 6 weeks, resistive exercises and wean from splint.
- Allow return to contacts sports when strength = &> 12 weeks.
- Review of our Rehabilitation Protocol:
- Phase I: Wound Healing (0-14 days)
- Protection - post op splint
- Edema Control - elevation
- Pain Control - analgesics
- Motion - AROM all other joints from DIP's to C-spine
- Phase II- Fracture Healing (2 days - 8 weeks)
- Protection - removable, forearm-based, lightweight, circumferential, thermoplastic spint with velcro closures (figure below) worn full-time, except during exercise sessions.
- Edema Control - elevation and compression glove (figure below)
- Motion - AROM of wrist and forearm out of splint. PROM and stretch to fingers, thumb and elbow while in splint.
- Strengthening - light putty for intrinsic strengthening as early as 4 weeks.
- Function - Progressive light functional use in splint
- Other - sutures out at 2 weeks. If supplemental K-wires used, leaves deep to skin and remove at 6-12 weeks.
- Phase 3: Function Recovery (8-12 weeks)
- Protection - wean from splint
- Motion - unrestricted
- Strengthening - stronger putty
- Function - increase to full use.
- Ultimately, I believe that rehabilitation is important related to
specific fixation type.
- Examples:
- Complex extra-articular fracture with joint angle effect.
- Original treatment non-bridging fixators
- Presented for second opinion after second manipulation
- Managed by pin care:
- Skin Release
- Alteration of splints
- Edema Control
- Analgesia
- Result equals acceptable outcome:
- Restoration of rotation
- Decreased edema and pain
- Key Rehabilitation = Fixation
Maintain Supination
Rom Fingers
Control Edema
Pain
- Final Case Example:
Comminuted Fracture
- joint angle abnormal
- joint surface abnormal
DRUJ stabilized by ORIF
Immediate rehabilitation
Flouroscopic motion demonstration
Summary:
The importance of the DRUJ and rehabilitation related to distal radius
fracture management deserves greater empahsis.
Stabilize the DRUJ for all cases.
Develop patient/fracture specific rehabilitation plans.
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Augumentation of Fracture Fixation: Bone Graft and Alternatives
Scott W. Wolfe, MD
Yale University School of Medicine
Department of Orthopaedics and Rehabilitation
- Distal Radius Fractures
- Historical Perspective
- Abraham Colles1
- Deformity accepted
- Optimal Outcome linked to:
- Restoration of volar tilt2
- Restoration of neutral ulnar variance3
- Carpal stability4
- Articular congruency5
- External fixation
- Historical results satisfactory6,7,8
- 75% recovery grip strength and ROM
- Avg immobilization 7 weeks (range 4-12)
- Ligamentotaxis
- Vidal described as salvage procedure for fractures not amenable to
osteosynthesis9
- Involves extremes of positioning
- Stress relaxation of ligaments with time
- Inadequate for volar or impacted fragments10
- Adverse effects of duration and amount of distraction8
- Bone grafting
- Clinical series show improved outcomes with earlier motion11,12
- Biomechanical work demonstrates sufficient stability to allow early
motion after partial healing13
- Clinical experience; high energy injuries - trend towards bone
graft (50 - 85%)
- Results demonstrate 80% and higher restoration grip and motion in
these high energy injuries14,15,16,17
- Indications
- Articular incongruency
- High energy injuries, dorsal or metaphyseal commination
- Late collapse, unstable extra-articular fracture
- Bone graft - The "Gold Standard"
- Autogenous Graft
- Advantages
- Highest biological activity
- Rapid integration
- Can be vascularized
- Disadvantages
- Limited quantity
- Donor site morbidity (6 - 30%)18
- Increased operative time/blood loss
- Increased cost/overnight stay
- Allograft
- Advantages
- Unlimited supply
- Strong, osteoinductive
- Disadvantages
- Finite risk of disease transmission
- Immunogenicity highly variable
- Fresh-frozen: osteoprogenitor cells killed
- Freeze-dried: lacks structural support
- Bone Graft "Substitutes"
- Prerequisite for bone graft substitute
- Osteoconduction
- Osteoinduction
- Osteogenic cells
- Structural support
- Bone graft alternatives
- Structural bone substitutes
- Osteogenic agents
- Cancellous bone substitutes
- Structural bone substitutes (cements)
- PMMA
- high rates of thermal necrosis; infection; brittle19
- Norian SRS
- Injectable ceramic, hardens to 50% strength in one hour
- Multicenter trial results encouraging for extraarticular
fractures20
- Bone Source
- can be mixed with blood or marrow21
- compressive strength 50 mPa
- TrueBond
- Peri-odontal applications; modular biodegradability
- Osteogenic agents
- Demineralized bone matrix (Grafton, Dynagraft)
- available in gel, strips, powder
- variable osteoinductivity
- no structural integrity
- may be mixed with marrow
- Bone Morphogenetic Proteins
- rhBMP-2; Encouraging in vivo results - canine
- Osteogenic Protein 1 (OP-1, BMP-7)
- Potent bone induction agent
- Laboratory and human defect/nonunion trials promising
- Others
- Ne-osteon
- Platelet concentrate
- Delivery Systems
- PLA/PGA
- collagen carriers
- Bioglass beads, variable resorption rates for timed
delivery22
- Cancellous bone substitutes
- Collagraft (Collagen-HA-TCP composite)23
- mixed with marrow to add osteoinductivity, osteogenic cells
- Calcium Phosphate Ceramics
- TCP; variable biodegradation
- Synthetic HA; high affinity for bone ingrowth; non-resorbable
- Coralline Hydroxyapatite
- Hydrothermal exchange reaction
- Porosity identical to cancellous bone; high affinity for growth
factors24
- Brittle, anisotropic
- Calcium Sulfate (Plaster of paris)
- Unpredictable biodegradation25
- Void filler
- Clinical Experience: Coralline Hydroxyapatite
- Methods
- Retrospective cohort; 19 high energy injuries
- Coralline hydroxyapatite cut to shape metaphyseal defect; augmented
K-wires, fixator
- Independent evaluation; therapist, radiologist, subjective outcome
questionnaire
- Objective outcome: Gartland & Werley; Green & O'Brien;
Knirk & Jupiter; Lidstrom
- Results
- Average followup 32 months
- 17/19 satisfied; no limitations sports/work/recreation
- Restoration of normal radiographic indices; no loss reduction with
time
- 17/19 good-excellent G-W; 14/19 good-excellent G-O
- 93% restoration range of motion
- Over 50% cost savings c/w iliac crest graft
- Summary
- Customized treatment for high energy distal radius fractures
- Bone graft accelerates healing time, reduces dependency on
ligamentotaxis
- Bone graft alternatives backed by clinical and basic laboratory
studies
- Rapid osseointegration; cost-effective
- Promising future for bone graft alternatives, bone regeneration
References
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AF, Edwards CC, eds. External fixation: current state of the art.
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Last modified 19/January/1999 by IS
