Background : Distal radius fractures following high energy trauma
are common injuries, usually associated with metaphysio-diaphyseal
comminution with marked soft tissue injury making effective
treatment a real challenge with high risk of complications. Minimally
invasive percutaneous plate osteosynthesis (MIPPO) is a fixation
technique giving priority for soft tissues and vascularity of the bone
fragments achieving a relatively stable fracture construct while
preserving a biologic environment insuring rapid bone healing. This
work aims to evaluate the outcomes of MIPPO technique for
treatment of distal radius fractures with metaphysio-diaphyseal
comminution.
Patients and methods : This prospective, case series study
comprised 11 cases of closed distal radial fractures with varying
degrees of displacement and metaphysio-diaphyseal comminution
following high-energy trauma. All fractures were treated by the
MIPO technique through two volar longitudinal incisions using a
volar locked plate bridging the comminuted segment. Patients were
followed up clinically and radiologically and the functional outcome
was evaluated according to Dienst wrist scoring system.
Results : All fractures united with a mean union time of 12.5 ± 1.6
weeks (ranged from 11 to 16 weeks) with no reported loss of fixation
with secondary displacement, implant failure or deep wound
infection. No cases needed any secondary surgical intervention to
achieve union. The follow-up period extended for a mean duration of
16.7 ± 3.2 months with satisfactory (excellent and good) clinical and
radiological results compared to the other side were achieved in all
cases. The radiological results (radial inclination, radial height and
volar tilt) were excellent in 8 cases and were good in 3 cases but the
clinical results (range of motion of the wrist and grip strength) were
excellent in all the 11 studied cases.
Conclusions : The results are very satisfactory, MIPPO minimizes
soft tissue compromise with preservation of the vascularity of the
comminuted fracture fragments, thus improving the healing rate,
shortening the time for union with no need for initial or delayed bone
grafting for such comminuted fractures with few potential
complications. |
