The Treatment Of The Distal Radial Fractures (AO Classification Type C2 And C3) With Minimally Invasive Restoration Combined With Dynamic External Fixator And Other Methods

[Objective] To summarize and evaluate the treatment effect of the distal radial fractures (AO classification type C2 and C3), using minimally invasive restoration combined with dynamic external fixator, or using open reduction and internal fixation (ORIF) combined with locking compression plate, or using manual reduction combined with plaster.[Method] From September 2011 to March 2014,90 patients with the distal radial fractures (AO classification type C2 and C3) were treated in our department, all the patients were followed-up.32 cases were treated with minimally invasive restoration combined with dynamic external fixator,30 cases were treated with open reduction and internal fixation (ORIF) combined with locking compression plate,28 cases were treated with manual reduction combined with plaster. We collected and sorted out the patients’X-ray data, the common surgery complications, as well as the wrists’ Gartland-Werley function scores, for statistical analysis.[Result] All of the patients have received bone union. After surgeries, the X-ray data showed that, in the external fixator group, palmar tilting angle (10.45±2.87)°, radial inclination angle (18.82±1.80)°, radial height (10.89±1.26) mm; in the LCP group, palmar tilting angle (10.73±2.28)°, radial inclination angle 18.94±1.76)°, radial height (10.50±1.43) mm; while in the plaster group, palmar tilting angle (6.83±2.38)°, radial inclination angle (14.32±2.78)°, radial height (7.58±1.61) mm. After 9 months, the X-ray data showed that, in the external fixator group, palmar tilting angle (10.48±2.80)°, radial inclination angle (18.89±1.77)°, radial height (11.00±1.33) mm; in the LCP group, palmar tilting angle (10.76±2.21)°, radial inclination angle (19.05±1.66)°, radial height (10.58±1.29) mm; while in the plaster group, palmar tilting angle (5.80±1.96)°, radial inclination angle (13.41±2.21)°, radial height (6.76±1.12) mm. There are 2 nail track infections,1 wrist joint pain,1 wrist joint stiffness in the external fixator group; 2 wound infections,2 wrist joint pains in the LCP group; 4 wrist joint pains,4 wrist joint stiffnesses,2 carpal tunnel syndromes in the plaster group. After 9 months, the wrists’Gartland-Werley function scores showed that, in the external fixator group, excellent/good 28; in the LCP group, excellent/good 28; while in the plaster group, excellent/good 16. After statistical analysis, the external fixator group and the plaster group was superior to cast(P<0.05), the LCP group and the plaster group was superior to cast(P<0.05), too. The external fixator group and the LCP group was pointless to cast(P>0.05).[Conclusion] The treatment of the distal radial fractures (AO classification type C2 and C3) with minimally invasive restoration combined with dynamic external fixator is an effective method. This method is simple, less invasive. It can effectively correct the shortening and angular deformity, making an anatomical reduction of the distal radial fractures, and strengthening the stability of the fractures. The treatment of the distal radial fractures (AO classification type C2 and C3) with open reduction and internal fixation (ORIF) combined with locking compression plate is an effective method, too. It can effectively correct the shortening and angular deformity, making an anatomical reduction of the distal radial fractures, and strengthening the stability of the fractures. In brief, the treatment of the distal radial fractures (AO classification type C2 and C3) with minimally invasive restoration combined with dynamic external fixator and open reduction and internal fixation (ORIF) combined with locking compression plate both have high scores on X-ray data and wrist joint function, and less surgical complications. In clinical application, we can select one of them flexibly according to the specific circumstances.