Abstract
Introduction: The balance between achieving stable fixation and maintaining hand and wrist function during the treatment of distal radius fractures has continuously plagued the orthopaedic surgeon. A radio-radial external fixation system was developed by Dr. Guillermo Bruchmann to address these concerns. This study was designed to evaluate the immediate functional and anatomical results of the fixation system on intra-articular and extra-articular fractures. This is the first study documenting the use of this technique in Asia.
Materials and methods: Fifty-four consecutive patients, 18 male and 36 female, with 56 distal radius fractures were treated with closed reduction and application of the COBRA radio-radial external fixator. The operative procedure is described in detail. Immediate use of the affected hand for activities of daily living (ADL’s) was encouraged. Each patient was evaluated regarding functional and anatomical recovery at 2, 4 and 6 weeks postoperatively. Using the modified system of Green and O’Brien, functional recovery was based on the presence of pain, ability to do ADL’s, and range of motion. The grading system of Sarmiento was used to evaluate the overall maintenance of anatomic reduction by comparing the post-operative radiographs with those taken at 2, 4 and 6 weeks and on removal of the fixator.
Results: Assessment of functional status showed that patients had occasional to no pain at the pin sites at 2 weeks; improving on biweekly follow-up. Those with extra-articular fractures were able to do restricted ADL’s wearing the device within the 1st 2 weeks; with wrist motion arc between 50–75°. Patients with intra-articular fractures were functionally delayed by 2 weeks but with a dramatic improvement at 3–4 weeks, doing light ADL’s with wrist motion between 20–60°; progressively improving on follow-up. Biweekly radiographic evaluation showed good to excellent maintenance of reduction for both intra- and extra-articular fractures up to time of fixator removal. Average time of fixation was 7 weeks (range, 6 – 9 weeks) with removal depending on radiographic evidence of fracture union.
Summary: The COBRA external fixator is a versatile tool in the treatment of intra-articular and extra-articular fractures that any general orthopaedic surgeon can use. The overall functional and anatomical outcome is good to excellent during the time of fixation up to the time of fixator removal. Hand and wrist function is initiated immediately markedly limiting the usual complications of stiffness and disability commonly associated with these fractures.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
