Non-Spanning
Syringe Distractor: An Alternative Technique for #Fracture Distal End
Radius Fixation for Rural Areas of Developing Countries with Limited
Resources by Mohit Jai in BJSTR
Abstract
Introduction: Operative fixation of distal radius fractures is
one of the most commonly performed orthopedic procedures. Though
external
fixator is a well-established method of treatment for unstable and
comminuted fractures, orthopedic surgeons from rural areas of developing
countries are still found to be hesitant to use it for various reasons.
Aim of our study is to provide an alternate technique for currently used
external fixator or distracter modules in limited resources and not to
substitute them.
Methods: A total of 32 elder patients with distal radius
fractures from a rural hospital were treated with a Non-Spanning Syringe Fixator
at a rural hospital which incorporates percutaneous K-wires used to fix
distal radius fractures after anatomical reduction. These patients
were evaluated for clinical and radiographic outcomes for 1 year and
compared with a historical control group of 30 patients with Hoffman II
external fixator construct by the same author but at the tertiary
center.VAS and DASH scores comparison was also done. Our study results
have
also been compared with various other known case series for treatment of
fracture distal radius by Gartland and Werley score.
Results: Mean radial tilt, 4 degrees; ulnar variance 0 mm and
radial inclination angle was 23 degrees at 1 year final follow up. Mean
loss
of wrist range of motion as compared to normal side was as follows:
flexion, 8 degrees, extension, 9 degrees; radial deviation, -1 degrees;
ulnar
deviation, 2 degrees ; pronation, -1 degrees ; and supination, 8
degrees. Average final DASH score was 9 ranging from 3-14.No
statistically
significant difference found in radiological and clinical variables or
DASH scores between control Hoffman II fixator group and study group of
Non Spanning Syringe Distractor. Using the Gartland and Werley score,
there were 24 (80%) excellent to good and 6 (20%) fair to poor results
which are quite comparable to other landmark studies.
Conclusion: External fixation has advantages over
conventional Plaster of Paris cast and pinning in the treatment of
unstable extraarticular
or simple intra-articular fractures of distal radius. Non Spanning
Syringe Distractor provides excellent to good results in majority of
our cases. It provides advantages of pinning and fixator both by
preventing wrist and hand stiffness and fracture collapse as well. The
Simplicity
of technique, less operative time, possible in minimal regional
anesthesia and cost effectiveness all together makes it very useful for
limited
resources scenario.
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