Surgical management of intra-articular impression distal radius fracture

Gilev M.V.

Abstract


Purpose
Improve results of surgical management of intra-articular impression distal radius fractures (DRF).
Material and methods
Retrospective study of 69 patients with intra-articular impression DRF surgically treated between 2011 and 2015 was performed. Inclusion criteria were impression intra-articular epimetaphyseal or metadiaphyseal defects seen on CT scan, open reduction and plating, and follow-up period of at least 36 months. Two groups of patients were identified to compare the effectiveness of new surgical technologies and bone grafting of impression defect applied in index group (n = 35) and conventional surgical technology with no graft in the control group (n = 34). Radiological, clinical and statistical methods of study were used. Parametric and non-parametric statistical tests were employed to evaluate significant differences. The difference between radial inclination (RI) and palmar tilt (PT) was measured to assess reduction persisted. DASH questionnaire (1996) was an outcome measure used for functional assessment.
Results
Intra-articular impression DRF were mostly seen in older adults and females with mean age of 48.9 ± 16.3 years. There were 14 (20.3 %) male and 55 (79.7 %) female patients. D.L. Fernandez type II fracture was most common (43.5 %). RI radiometric parameters measured 13.34 ± 0.43 ° in index group and 9.33° ± 0.51° (p = 0.003) in the control group at 3-month follow-up. RI was noted to decrease in the control group and showed maximum values of 3.71° ± 0.31°, p less 0.05 at 3-month follow-up. Excellent and good results were observed in index group at 36-month follow-up measuring DASH score of 94.2 % vs. 61.8 %, p less 0.05.
Conclusion
Surgical repair of intra-articular impression DRF combined with new approach and modern bone grafting materials facilitated restoration of optimal radiometric parameters of the distal radius with bone graft preventing secondary impression and providing reliable bone fixation with the possibility of early rehabilitation.

Keywords


radius, intra-articular fracture, impression fracture, bone graft, surgical treatment

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