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Palmar Reduction And Internal Fixation For Displaced Intraarticular Fractures Of The Radius With Locking Compression Plate: Operative Strategy Lead To Functional Treatment

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Author(s): Manfred Infanger

Journal: Journal of Orthopaedics
ISSN 0972-978X

Volume: 3;
Issue: 3;
Date: 2006;
Original page

Keywords: fracture radius | interlocking plate | palmar reduction | internal fixation

ABSTRACT
Background: The treatment of the distal intraarticular radius fracture is controverse discussed. Dorsal displaced, unstable and intraarticular compression fractures of the distal radius are commonly treated by external fixations, K wires or open reduction and internal fixation (ORIF) with dorsal plating. If instability criteria are encountered with bone grafting. All afore mentioned methods show significant morbidity and do not provide stability. Functional loss after immobilisation, secondary loss of reduction, pininfections, tendon ruptures and M.Sudeck are commonly encountered complications. These results after common distal radius fracture treatment and with special regard to interference with the surrounding soft tissue, have encouraged us to stabilize dorsal displaced unstable and intraarticular fractures through a palmar approach. Methods: We describe the surgical treatment with approach, technique of new minimal invasive reduction an internal ankle stable fixation, our results obtained with this method over 1 year with 81 patients (AO classification A: 24.7%, B: 6.2%, C: 69.1%). Using this palmar approach and the minimal invasive open reduction technique, new internal fixation device utilizing the locking compression plate with fixed angle screws, we avoid the soft tissue problems associated with dorsal plating. We achieve also by intraarticular fractures stability for functional treatment and last but not least, we don’t need bone grafting. Results: A follow up time of 12 months the fractures heated with highly satisfactory radiographic, and functional results, mean age 54,3 years. The overall outcome according to the Gartland and Werley score showed 49% excellent, 41% god, 9%fair and 1% poore results. DASH Score 15 points after 12 months (before trauma 6,8). Our experience indicates that all types of distal dorsal displaced and intraarticulare radius fractures can be anatomically reduced and fixed through a palmar approach without loss of reduction results. Conclusions: This technique offers in our opinion several advantages: the stronger palmar cortex of the radius, no tuch from the vascularisation of the bone, possibility of minimal invasive reduction. The combination of minimal invasive reduction and stable internal fixation with preservation of the dorsal soft tissues rapid functional treatment resulted in rapid healing, no need for bone grafting no incidence of tendon problems in our study in young such as older patients
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