Prospective Evaluation of The Results of External Fixation of Unstable Fractures of Distal Radius- A Comparison Between Open and Close Fractures and an Analysis of Similar Studies

Background: Unstable or severely comminuted and intra-articular fractures of distal radius represent traumatic high energy injuries. Prospective study to evaluate the results of external fixation of such fractures was conducted from January 2017 to January 2020 in the Department of Orthopaedics. The aim of this study is to identify the results of external fixation of unstable fractures of distal radius and find out the best treatment options for such fractures under different clinical conditions by comparing the results for open and close fractures and analysis of similar studies. Materials and Methods: 50 cases of unstable distal radius fractures, including 25 patients with open fractures and 25 patients with close fractures, were treated by external fixation. The patients had mean age of 33 years with 3:2 male female ratio. The fracture was anatomically reduced and fixed with external fixator. The mean follow up was of 24 months. Results: Final assessment was done at 6 months postoperative follow up using the Sarmiento’s modification of Lindstrom criteria for radiological outcome, showing excellent to good results in 60% cases among open fracture group and 80% cases among close fracture group , Mayo Wrist Score for functional outcome showing excellent to good results in 52% cases among open fracture group and 76% cases among close fracture group. Long term assessment done using Jakim’s scoring system (for clinicoradiological correlation) at 24 months follow-up for all 50 patients, showed excellent to good results in 88% patients. Analysis of similar studies shows external fixation to be the most rewarding treatment option for varied clinical presentations of unstable fractures of distal radius. Conclusions: Outcome at 6 months is significantly better in close fracture group as compared to open fracture group showing that good soft tissue cover is necessary for functional fracture healing. The long-term outcome in majority of the patients (44 cases) was excellent to good showing reliability of biological ligamentotaxis under various clinical presentations as suggested by analysis of similar studies. This treatment of choice leads to clinically rewarding functional, anatomical and radiological outcomes in unstable distal radius fractures. Keywords: External fixation, ligamentotaxis, Distal radius.