Hamed Abuelkhair, MD, Mohammed Elsadek, MD, Waleed Faisal, MD
Background: Pathoanatomy & biomechanics of radiocarpal & radioulnar joints have pivotal role in maintaining wrist functions and movements. Problems associated with these fractures hamper strength of grip and early arthritis with carpal instability.Patients and methods: Twenty four patients with unilateral distal radius fracture associated with intercarpal fractures and dislocations who were managed by treatment protocol of primary external fixation for ligamentotaxes until edema subsided, followed by secondary stage of plate fixation of distal radius, k-wire fixation of intercarpal ligamentous injury, and Headless compression screw fixation for carpal scaphoid fractures. The patients were evaluated according to standard objective and subjective criteria using demerit-point system of Gartland and Werley & patient rated wrist evaluation score (PRWE).Results: Fourteen patients (70%) had excellent to good outcome based on Gartland and Werley score, and six patients had fair outcome. Radiologically, excellent to good results were found in 80% of the patients with loss of radial inclination less than 10 degrees, average radial shortening (4mm) ranged from 3-6 mm. The average palmar tilt at final follow up was around 7 degrees (3-14).Conclusion: The technique of primary external fixator, followed by plate osteosynthesis can be utilized in comminuted intra articular fractures lower radius associated with screw fixation for individual carpal bone fixation and k wire for intercarpal instability due to ligamentous injuries. The adequate surgical technique will minimize complications and an optimized rehabilitation regime can give the best possible result. Accurate anatomical reduction of the articular surface and stable fixation are mandatory for better functional outcome.
