Distal forearm fracture in the adult: is ORIF of the radius and closed reduction of the ulna a treatment option in distal forearm fracture?

  • Martin Gschwentner
  • Rohit Arora
  • Markus Wambacher
  • Markus Gabl
  • Martin Lutz
Trauma Surgery

Abstract

Introduction

Distal forearm fractures in younger adults are rare injuries resulting from high energy trauma. Treatment options vary from cast fixation, external fixator, percutaneus pinning and open reduction and internal fixation.

Method

We retrospectively reviewed 13 patients aged 18–59 from 1996 to 2005 with a distal unstable forearm fracture. All were treated with open reduction and internal fixation of the radius. The ulna was stabilized either by an open reduction and internal fixation or by a closed reduction with or without pin fixation and cast fixation in all cases. At follow-up, we evaluated the radiologic results in terms of forearm fracture retention and functional outcome according to the wrist score by Krimmer.

Result

Radial inclination amounted to 24° at the injured side when compared to 27° at the non-injured side, palmar tilt was 3° versus 7° and ulna variance was −2 versus −1 mm. According to the modified wrist score by Krimmer, seven excellent, two good and four fair results were achieved. The range of motion of the injured wrist joint was 149°of rotation, in the sagittal plane 106°, frontal plane 61° and on the non-injured side rotation was 171°, and movement in the sagittal plane was 146°and 79° in the frontal plane. Decreased forearm rotation (107° vs. 162°) and decreased range of motion in the sagittal plane (77° vs. 114°) were measured in patient following open reduction and internal fixation of radius and ulna compared to the outcome in patients with open reduction and internal fixation of the radius and closed reduction of the ulna. Grip strength of the injured side averaged 350 N versus 440 N which is 76% of that of the opposite side. All patients stated no pain at rest and some experienced slight pain at work. Three patients had an excellent performance at daily activities, nine patients presented problems with certain activities, and one patient showed severe limitations.

Conclusions

Open reduction and internal fixation of the radius is the keystone in treating distal forearm fracture. In case of stable retention of the ulnar head after closed reduction, cast fixation with or without percutaneus pin fixation is a sufficient method to treat unstable distal forearm fractures. In patients with remaining instability of the distal ulna fracture, ORIF is indicated.

Keywords

Distal forearm fracture Young adult Radius plate fixation Ulna Closed reduction Pin fixation 

Abbreviations

DRUJ

Distal radioulnar joint

ORIF

Open reduction internal fixation

VAS

Verbal analogue scale

MVA

Motor vehicle accident

ROM

Range of motion

References

  1. 1.
    Aufranc OE, Jones WN, Bierbaum BE (1968) Fracture of the distal radius and ulna. JAMA 205:296–299PubMedCrossRefGoogle Scholar
  2. 2.
    Biyani A, Simison AJ, Klenerman L (1995) Fractures of the distal radius and ulna. J Hand Surg (Br) 20:357–364Google Scholar
  3. 3.
    Bossi E, Azzoni R, Riva R, Ronzani C, Sinigaglia G (1984) External fixation in the treatment of fractures of the distal forearm. Ital J Orthop Traumatol 10:341–348PubMedGoogle Scholar
  4. 4.
    Chung KC, Spilson SV (2001) The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg (Am) 26:908–915CrossRefGoogle Scholar
  5. 5.
    Dennison DG (2007) Open reduction and internal locked fixation of unstable distal ulna fractures with concomitant distal radius fracture. J Hand Surg (Am) 32:801–805CrossRefGoogle Scholar
  6. 6.
    Flinkkila T, Ristiniemi J, Hyvonen P, Hamalainen M (2003) Nonbridging external fixation in the treatment of unstable fractures of the distal forearm. Arch Orthop Trauma Surg 123:349–352PubMedCrossRefGoogle Scholar
  7. 7.
    Forward DP, Lindau TR, Melsom DS (2007) Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 89:2334–2340PubMedCrossRefGoogle Scholar
  8. 8.
    Geissler WB, Fernandez DL, Lamey DM (1996) Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop Relat Res 135–146Google Scholar
  9. 9.
    Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL (1996) Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 78:357–365PubMedGoogle Scholar
  10. 10.
    Goldfarb CA, Rudzki JR, Catalano LW, Hughes M, Borrelli J Jr (2006) Fifteen-year outcome of displaced intra-articular fractures of the distal radius. J Hand Surg (Am) 31:633–639CrossRefGoogle Scholar
  11. 11.
    Green DP, O’Brien ET (1978) Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg (Am) 3:250–265Google Scholar
  12. 12.
    Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458PubMedGoogle Scholar
  13. 13.
    Hager CG (1992) The distal radioulnar joint in relation to the whole forearm. Clin Orthop Relat Res 56–64Google Scholar
  14. 14.
    Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68:647–659PubMedGoogle Scholar
  15. 15.
    Krimmer H, Wiemer P, Kalb K (2000) Comparative outcome assessment of the wrist joint–mediocarpal partial arthrodesis and total arthrodesis. Handchir Mikrochir Plast Chir 32:369–374PubMedCrossRefGoogle Scholar
  16. 16.
    Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg (Br) 22:638–643Google Scholar
  17. 17.
    Lutz M, Arora R, Smekal V, Krappinger D, Gschwentner M, Rieger M, Pechlaner S (2007) Long-term results following ORIF of dorsal dislocated distal intraarticular radius fractures. Handchir Mikrochir Plast Chir 39:54–59PubMedCrossRefGoogle Scholar
  18. 18.
    McKee MD, Waddell JP, Yoo D, Richards RR (1997) Nonunion of distal radial fractures associated with distal ulnar shaft fractures: a report of four cases. J Orthop Trauma 11:49–53PubMedCrossRefGoogle Scholar
  19. 19.
    Müller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, BerlinGoogle Scholar
  20. 20.
    Palmer AK, Glisson RR, Werner FW (1984) Relationship between ulnar variance and triangular fibrocartilage complex thickness. J.Hand Surg (Am) 9:681–682Google Scholar
  21. 21.
    Pechlaner S (1993) Distal intra-articular radius fractures. Indications for and technique of open reduction and plate osteosynthesis. Orthopade 22:46–51PubMedGoogle Scholar
  22. 22.
    Pechlaner S, Kathrein A, Gabl M, Lutz M, Angermann P, Zimmermann R, Peer R, Peer S, Rieger M, Freund M, Rudisch A (2002) Distal radius fractures and concomitant lesions. Experimental studies concerning the pathomechanism. Handchir Mikrochir Plast Chir 34:150–157PubMedCrossRefGoogle Scholar
  23. 23.
    Prince H, Worlock P (1988) The small AO external fixator in the treatment of unstable distal forearm fractures. J.Hand Surg (Br) 13:294–297Google Scholar
  24. 24.
    Ring D, McCarty LP, Campbell D, Jupiter JB (2004) Condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius. J.Hand Surg (Am) 29:103–109CrossRefGoogle Scholar
  25. 25.
    Rossillon D, Boute B, Hubert M, Evrard H (1987) Study on the external fixator in the treatment of the fractures of the inferior end of the two bones of the adult’s forearm. Report of fifty-five cases. Ann Chir Main 6:25–30PubMedCrossRefGoogle Scholar
  26. 26.
    Walz M, Kolbow B, Mollenhoff G (2006) Fracture of the distal ulna accompanying fracture of the distal radius. Minimally invasive treatment with elastic stable intramedullary nailing (ESIN). Unfallchirurg 109:1058–1063PubMedCrossRefGoogle Scholar
  27. 27.
    Wigg AE, Hearn TC, McCaul KA, Anderton SM, Wells VM, Krishnan J (2003) Number, incidence, and projections of distal forearm fractures admitted to hospital in Australia. J Trauma 55:87–93PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Martin Gschwentner
    • 1
  • Rohit Arora
    • 1
  • Markus Wambacher
    • 1
  • Markus Gabl
    • 1
  • Martin Lutz
    • 1
  1. 1.Department of Trauma Surgery and SportsmedicineMedical University of InnsbruckInnsbruckAustria

Personalised recommendations