Session V - Post Traumatic Reconstruction

Fri., 10/19/01 Post Traumatic Reconstruction, Paper #29, 9:28 AM

*Open Reduction Internal Fixation of Ununited Fractures of the Distal Radius: Does the Size of the Distal Fragment Affect the Result?

David Ring, MD; Karl Prommersberger, MD; Diego Fernandez, MD; Jesse B. Jupiter, MD, Massachusetts General Hospital, Boston, MA (all authors ­ a-AO Foundation)

Introduction: Ununited fractures of the distal radius once thought to be exceedingly rare are now frequently discussed. Many surgeons advise against attempts to gain healing when the distal fragment is less than 6 mm in size (measured at the lunate facet), suggesting the use of total wrist arthrodesis instead.

Methods: Twenty-three patients with ununited fractures of the distal radius underwent plate fixation and autogenous bone grafting in an attempt to heal an ununited fracture of the distal radius. The 10 patients in whom the distal fragment had less than 6 mm of subchondral bone at the lunate facet were compared with the 13 patients who had a larger distal fragment.

Results: At an average follow-up of 28 months, one patient had persistent nonunion (large-fragment cohort) treated with wrist arthrodesis. Two patients required a subsequent operation for distal radioulnar joint dysfunction (Bower's arthroplasty one large-, one small-fragment cohort). An average of 40° of wrist flexion was preserved in the small-fragment cohort compared with 50° in the large-fragment cohort. According to the rating of Fernandez, only four patients in the small-fragment cohort and three patients in the large-fragment cohort had good or excellent results, reflecting the salvage nature of these procedures.

Conclusions: These data suggest that operative attempts to gain union of an ununited fracture of the distal radius are worthwhile, even when the distal fragment is small. Although there may be minimal subchondral bone beneath the lunate facet, the radial styloid offers sufficient bone for the application of one or more internal fixation devices. Surgeons should try to preserve even a small amount of wrist flexion and reserve the use of wrist arthrodesis as a final resort.