Year Book: Fractures of the Lower End of the Radius Anteriorly Displaced
Treated by Plating. Ducloyer, P. Kerboul, M. Abstract/Commentary:|1992 Year Book of Hand Surgery. Article 9-14.|Original Article:|Rev Chir Orthop. 1990. 76. pp 451-459.. Background.--Anteriorly displaced fractures of the distal radius are relatively rare. In type I fractures, an anterior fragment comprising a more or less important portion of the articular surface and the radial styloid are detached at the margin. This fragment may either be intact or comminuted, but the posterior margin remains intact. A type II anteriorly displaced radial fracture comprises either a simple or complex fracture of the anterior margin combined with either a displaced or nondisplaced fracture of the posterior margin (Fig 9-9). Careful attention should be given to potential posterior fractures because they are not always easily seen on radiographs. The radial styloid can be detached with either type of fracture. Before 1964, open reduction for these unstable fractures rarely was recommended. Since 1972, a preformed anterior fixation plate, which is available in 6 sizes and in thicknesses of 2 and 3 mm, has been used. Methods.--Between 1972 and 1986, 32 females and 25 males, aged 18-81 years, were treated for 58 anteriorly displaced radial fractures. One woman had bilateral involvement. There were 23 type I fractures, 30 type II fractures, and 5 Goyrand-Smith fractures. Thirty-five fractures were treated by primary intention and 22 were operated on after simple immobilization without reduction had failed. All patients were operated on by a palmar approach. Results.--Infection developed in 1 patient, necessitating reoperation on day 15. Failure to open the carpal tunnel resulted in 6 cases of median nerve compression, 5 of which required removal of the plate and medial nerve decompression 3 months to 3 years after operation because of persistent pain. There were 13 secondary displacements, including 2 after Goyrand-Smith fractures, 2 after type I fractures, and 9 after type II fractures. A total of 30 complications affected the outcome of 20 fractures, but most resulted from errors in surgical technique. In all, 10 plates had to be removed. After a follow-up of 3 months to 13 years, 7 patients could not be traced. The clinical results in the remaining 51 fractures were rated very good or good in 76.5%, average in 19.6%, and poor in 3.9%. Radiographic results were rated very good or good in 68.6%, average in 7.8%, and poor in 23.6%. Initial good results later deteriorated because of arthritis in 2 patients. Conclusions.--Precise surgical technique is the best guarantee for a favorable functional outcome. Anatomical reduction with solid fixation of all fragments is essential because it enables early wrist mobilization and avoids complications of the nerve and tendon.
Original Text by Clifford R. Wheeless, III, MD.
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