A new technique for distal forearm fractures: the external radius fixator
István Kádas, János Szita, Antal Renner, Zsolt Vendégh, Balázs Gloviczki
National Institute of Traumatology and Emergency, Budapest, Hungary
Keywords: Equipment design; external fixators; fracture fixation/instrumentation; fractures, comminuted/surgery; radius fractures/surgery/radiography; wrist injuries.
In fractures of the distal forearm of type B3-C2-C3 according to the Müller classification, besides adaptation wire fixation we use an external fixator as an absolute indication. Ligamentotaxis is the basic principle of the therapy and the results of this treatment are well-known. Herein, a new external fixation technique, “radius fixator”, is described whereby adequate stability can be achieved with adaptation wires even without ligamentotaxis. After reduction, two K-wires of 2-mm thread are used for stabilization. The surgical approach begins above the styloid process of the radius and ends on the ulnar cortical surface of the radius proximal to the fracture. The two K-wires make an angle of 30 to 40 degrees in both planes. The next step is the insertion of Schanz screws, 3 mm in diameter, into the radius at an angle of 60-90 degrees to one another in the radial and dorsal directions and in a rectangular position to the longitudinal axis of the radius. The K-wires and Schanz screws are connected with rods, 4 mm in diameter, in longitudinal, parallel or crossed position. Using this technique, we treated 45 patients with fractures of type A3-B2-B3-C1 according to the Müller classification. Radiographic and functional results were good-fair in 89% and 94%, respectively. The reconstruction of the skeleton and its stabilization with K-wires and Schanz screws, rods, and clamps is appropriate. The carpal joint is not immobilized by the external radius fixator, and its function will not be compromised during a 6-week fixation.