gms | German Medical Science

Objectives/Interrogation: A retrospective group study was carried out to evaluate the effect of the external Ilizarov apparatus on treating acute intra-articular fractures.

Methods: Between September 2015 and December 2017, 58 patients with articular distal radius fractures were treated by closed reduction and external fixation with Ilizarov apparatus. The mean age at the time of surgery was 63.7 (ranging 47 to 69 years old). The fractures were categorized according to the AO system: 16 cases of B2,B3 and 42 cases of C1,C2.

The follow-up period was 19 months (ranging 8 to 24 months). In 35 cases, the traditional osteosynthesis (with typical Ilizarov apparatus) was performed which implied inserting K-wires (6-7 pins total) into the proximal and distal radius fragments. In 23 cases, under local anesthesia, the osteosynthesis was performed by Ilizarov apparatus on an outpatient basis. Simplified Ilizarov constructions allowed implementing ligamentotaxis, while the radius and metacarpal bones were fixed by only 3-4 K-wires. The fixation time in the external fixation apparatus averaged 33±4 days. After removing the external fixation apparatus, the patients were engaged in exercise therapy of wrist joint and finger joints for 1.5-2 weeks.

Results and Conclusions: All fractures were healed in a mean of 5.2 weeks (ranging 4 to 7 weeks). At the final follow-up (in 6 months after the surgery), the average motion range was 77.3±10.3 in flexion, 59.6±3.9 in extension, 68.5±9.8 in pronation, and 62.4±12,3 in supination. The overall clinical and functional outcomes, according to the Gartland and Werley scoring system, showed that 22 patients (31.4%) had excellent results, 36 (51.4%) had good results, 9 (12.9%) had fair results, and 3 (4.3%) had poor results.

Patients who underwent traditional surgical treatment had positive results in 68.5% of cases, satisfactory results and poor results totalled 31.5% of cases in the form of persistent wrist joint contractures and malunions. In the group of patients who underwent surgical treatment with a simplifed Ilizarov apparatus, positive results were achieved in 86.9% of observations, while 13.1% revealed wrist joint contractures. Malunions were not detected.

Closed reduction and external fixation with the Ilizarov apparatus is useful and effective in management of displaced comminuted articular fractures of distal radius. Simplified Ilizarov apparatuses should be preferred.