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Original Article

Hand Microsurg. 2012; 1(1): 10-16


Treatment of distal radius fractures with external fixation, limited open reduction and dorsal autologous cancellous onlay bone grafting

Mordechai Vigler, J. Henk Coert, Alexander John Kaminsky, Richard S. Gilbert, Michael R. Hausman.

Abstract
Objectives: Distal radius fractures with their high incidence, are commonly encountered and have many methods for treatment. External fixation with grafting supplementation is still utilized by many surgeons today achieving good subjective and objective outcomes. We have modified previously reported external fixation with supplementation techniques to decrease the amount of graft utilized and have evaluated the outcomes.
Methods: This retrospective study of 29 patients evaluates a treatment technique of a dorsal autologous cancellous iliac crest bone onlay graft with external fixation and limited open reductions for distal radial fractures. Range of motion, grip strength and radiographic outcome were scored. The mean follow-up was 2.5 years.
Results: Supplemental fixation was utilized in 8 of the 29 cases, 6 with percutaneous Kirschner wires and 2 with internal fixation with screws but without plates. The overall complication rate was 6 out of 29, of which, only 3 patients had loss of reduction, 1 with 5 mm loss of radial height, and 2 with 2 mm loss of articular congruity, but all with good/excellent outcomes. There were 79% good/excellent results and 21% fair results, using the Green and O’Brien classification.
Conclusion: Compared to current published results of distal radial fractures treated with external fixation supplemented with packed intramedullary autologous cancellous iliac crest graft, our dorsal on- lay technique is as effective a treatment modality. Additionally, there are several advantages including less bone graft to be harvested and associated morbidity.

Key words: Autologous cancellous bone graft, distal radius fracture, dorsal on-lay graft, external fixation.


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