Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures

Balasubramaniam, S (2013) Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Fractures of distal radius are most common fractures of the upper extremity forming about 17 % of all fractures. Distal radial fractures have a bimodal age distribution, consisting of a younger patients sustaining injury due to relatively high-energy trauma and an elderly patients sustaining low energy trauma. Around 50-70 % of the distal radius fractures are associated with distal ulna fractures following a rise in the high energy trauma in recent years. The treatment of distal radius fracture has seen a tremendous evolution from cast immobilization through Kirschner wire fixation to internal fixation with various plates. The significance of distal ulna fractures is often not appreciated and treated inadequately in comparison to its larger counterpart; the radius. The goals of the treatment of distal radius fractures are to restore joint line congruity, joint stability and alignment with minimal soft tissue dissection to allow for early mobilization and establishment of good function, but this early mobilization cannot be undertaken confidently without a stable distal ulna and distal radio ulnar joint. AIM: To analyse the short term Functional Outcome following internal fixation of distal ulna fractures with concomitant distal radius fractures done in our Institute of Orthopaedics and Traumatology, Madras medical College and Rajiv Gandhi Government General Hospital between the period of May 2011 and November 2012. MATERIALS AND METHODS: This study was designed to review the Short Term Functional and Radiological outcomes of the treatment of fracture both bones distal forearm by Internal fixation of both the distal ulna and distal radius. From May 2011 to Nov 2012, 28 consecutive fractures of distal ulna with distal radius in skeletally matured patients were managed primarily by internal fixation with locking compression plate, Kirschner wire, External fixator, Ellis plate, T plate, tension band wiring, Lag screw or a combination of these. The criteria for patient selection were as follows; Inclusion Criteria - 1. Age more than 18 years, 2. Fractures involving both the distal radius and distal ulna with in 5 cm for the joint line, 3. Muller’s type II B (unstable) and type III B (potentially unstable) distal ulna fractures, 4. Fractures under Frykman classification II, IV, VI, VIII, 5. Closed fractures, 6. Associated distal radius fracture. Exclusion Criteria: 1. Age less than 18 years. 2. Isolated distal ulna or distal radius fractures, 3. Undisplaced fracture, 4. All open fractures, 5. Neglected fractures more than 3 weeks, 6. Severe co-morbidities, 7. Unco-operative and unwilling patient, 8. H/O previous wrist pathology or malunited distal radius fracture. Patients of both sexes were recruited in the study according to the devised inclusion and exclusion criteria. Patients presenting in the Emergency department and the Outpatient department were admitted for thorough evaluation. Detailed history taking was done to ascertain the duration of injury, mode of injury, co morbid illness, and history of previous surgeries and for ruling out any kind of head injury or other system involvement. RESULTS: The mean follow up was 8.8 months, range being 4 months to 18 months. 25 of the 28 patients had regular follow-up. Two patients are lost to follow-up after 2 months of surgery due to social reasons. One patient in his ninth decade expired in the second post-operative month following myocardial infarction. Hence results of only 25 patients were analyzed. Two patients who were treated with kirschner wire alone following closed reduction had malunion with significant dorsal angulation with negative palmar tilt. CONCLUSION: From our study, we conclude that Primary fixation of the distal ulna fractures along with distal radius fractures is essential for good functional outcome and to avoid distal radio ulnar instability. Necessity of new classification for distal radius fractures associated with distal ulna fractures is evident for planning the management and for prognostic evaluation. Conservative management or internal fixation with Kirschner wires alone is not sufficient. Stable fixation of the distal ulna fractures can be obtained using tension band wiring or lag screw for ulnar styloid process fractures and 1/3rd locking tubular plate for ulnar head and neck fractures. Hence the evidence for primary Distal Ulna fixation is more compelling. However long term follow up is needed to further validate our findings.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Short Term Functional Outcome Analysis ; Internal Fixation ; Distal Ulna Fractures ; Concomitant Distal Radius Fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 03:25
Last Modified: 14 Sep 2017 03:25

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