Twelve Years Follow-up of Fractures of the Distal Radius Treated with the AO External Fixator

From 1977 to 1982 a total of 55 patients suffering comminuted fracture of the distal radius were treated with the external fixator. Fifty of these were followed up in 1983/85 and 32 of them were available for assessment in this study (1992). The follow-up period was 11.6 years on average. All patients had suffered an intra-articular fracture (91% a C-fracture, 9% a B-fracture according to the AO classification), 27 patients had also fractured the ulnar styloid process and in 11 a dye-punch fragment was present. Both wrists were assessed on the basis of case history, clinical examination, radiographs in two planes and visual analogue scales (VAS). The results were evaluated using established scoring systems. On the Gartland and Werley scale 75% of the results were good or very good, 63% according to Castaing. In general, there was no statistically significant difference between the results of this study and those of 1983/85. It could be demonstrated that there was a relationship between arthritis as a late complication and the existence of an intra-articular step-off of at least 2 mm at implant removal. This also has a negative influence on the range of motion and strength. Radial shortening affects the functional result whereas a die-punch fragment does not. On VAS patients identified performance restriction and disability as the worst consequences of the accident; these criteria correlated best with the results of objective evaluations. In contrast, patients were more satisfied with the result of treatment than would be expected from the objective analyses. The overall results indicate that exact reduction was extremely important. Long-term follow-up showed that the use of the external fixator in the treatment of comminuted intra-articular fractures of the distal radius was an adequate method. Prospective and possibly multicentric studies would be required to investigate more detailed relationships between treatment and long-term results.