Article
PROXIMAL AND MIDCARPAL INSTABILITY FOLLOWING COMPLEX DISTAL RADIUS FRACTURES
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Published: | November 11, 2003 |
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Outline
Text
Fragestellung
The evaluation of operative stabilization of ligamentous trauma of the wrist following compex distal radial fractures.
Methoden
Twenty-four intraarticular fractures of the distal radius associated with ligamentous injuries of the carpus were operatively treated between 1998-2002. Reduction and stabilization of the fracture was performed by augmented external fixation. Disruption of the scapholunate ligament, dorsal radiocarpal ligament and V-ligament was found in 14, 6 and 4 cases respectively. The associated proximal or/and midcarpal instability was restored by ligament repair and stabilization of the rotational center of the wrist with mini-Mitec® bone anchors. Final assessment was performed according to Mayo Wrist Score and cinematographic evaluation of the wrist motion.
Ergebnisse
All distal radial fractures were healed between six to seven weeks. Dynamic evaluation of the wrist revealed almost normal carpal kinematics. The final outcome was excellent in 16 cases (66.7%), good in 6 (16.7%), fair in 1 (8.3%) and poor in 1 (8.3%) cases. A residual scapholunate dissociation of 3 mm was found in one case, whereas limitation of volar flexion (up to 35o) was observed in all cases postoperatively, but it improved with intensive physiotherapy.
Schlussfolgerungen
Ligamentous injuries of the wrist are frequently present in distal radius fractures. Exclusive repair of all structures is difficult and sometimes impossible. We have found that proper restoration of the load-bearing column with a good rotation center of the wrist can give excellent results.