Ligamentotaxis and Bone Marrow Injection to Prevent Late Metaphyseal Collapse in Distal Radius Fractures

Title: Ligamentotaxis and Bone Marrow Injection to Prevent Late Metaphyseal Collapse in Distal Radius Fractures

Authors: Dr Shibu R, Dr Biju S, Dr Sabarisree M

DOI: https://dx.doi.org/10.18535/jmscr/v5i6.190

Abstract

Introduction: To compare the results of external fixator augmented with bone marrow injection in the management of distal radial fractures with that of fixator alone in preventing late metaphyseal collapse

Materials and Methods: Patients with severely comminuted metaphyseal fracture of the distal radius were only included in the study. The fractures were of Frykman-VII or Frykman-VIII types and reducible unstable type as per universal classification.

Results: 93.3% of cases in Group-II, showed good to excellent anatomical results after one year and only 56.7% in Group-1 (p<0.005). Functional results were good to excellent in 90% in Group-II and it was 56.7% in Group-I (p<0.02). This shows that Group-II patients who were treated by bone marrow injection along with ligamentotaxis obtained better results and it is statistically significant also. Comparison of the anatomical results to functional result showed that good anatomical result was a prerequisite for good functional result.

Conclusion: External fixators based on the principle of ligamentotaxis gives better anatomical and functional results initially, but on follow-up results deteriorate due to late metaphyseal collapse, which can be effectively prevented by injection of bone marrow into the metaphyseal defect.

References

1. Ahlborg HG, Josefsson PO.Pin tract complications in external fixation of fractures of distal radius.Acta Orthop Scand 1999 Apr;70(2);116-8.

2. Anderson. R and O'Neill G. Comminuted fractures of the distal end of the radius. Surg Gynaecol Obstrect 78:434, 1944.

3. Asche. G. Treatment of radius fractures with newly developed dynamic external fixator, Zentra Ibl Chair 120 (12):952-8, 1995.

4. Benayahu D,Klettu Y,Zipori D,Wientroub S. Bonemarrow derived stromal cell line expressing osteoblastic phenotype in utero and osteogenic capacity in vivo. J Cell Physiol 1989;140:1-7.

5. Brady 0, Rice. J. Nicholson. P. The unstable distal radius fracture oneyear post Kapandji intrafocal pinning.Injury 1999 May 30(4) 151-5.

6. Byl NN,Kohlhase W, Engel G. Functional limitation immediately after cast immobilization and closed reduction of distal radius fractures;preliminary report. J Hand Ther 1999 Jul-Sept;12(3);201-11.

7. Cannegieter DM, Juttmann J.W. Cancellous grafting and external fixation for unstable Colles fractures JBJS. Br. 79(3):428.32, 1997.

8. Charles. P. Melone. Acute fracture and dislocation of carpus, Symposium on wrist. Orthopedic clinics of North America, 1983.

9. Colles. A. On the fracture of the carpal extremity of the radius Edinburgh Medical and Surgical Journal 1814, vol 10: 182

10. Connolly JF ,Guse R,Tiedmann ),Define R.Autologous marrow injection as a substitute for operative grafting in tibial nonunions. Clin Orthop 1991;266:259-70.

11. Cooney W.P, Linschield R.L. and Dobyns J.H External pin fixation for unstable Cones fracture JBJS. 6, A: 840, 1979. Injury 2000;31 Suppl 1;48-55.

12. Dee W,Klein W,Rieger H. Reduction techniques in distal radius fractures.

13. De Palma AF. Comminuted fractures of the distal end of radius treated by ulnar pinning. MS 34A:651, 1952.

14. Dodds SD,Cornelissen S,Jossan S,Wolfe SW. A biomechanical comparison of fragment-specific fixation and augmented external fixation for intraarticular distal radius fractures.) Hand Surg(AM) 2002Nov;27(6):953-64

15. Dowling 3.3 and Sawyer Blackwell 3. Comminuted Colies fracture, evaluation of a method to treatment IBIS 43. A: 657-668, July 1961.

16. Freiburg, Seven and Lindstorm Radiographic measurement of the radio carpal joint in normal adults. Acta Radiol Diag 17:249 - 256, 1976.

17. Frykman, Gosta, Fractures of the distal radius including sequelae- Shoulder Hand Finger syndrome, disturbance in the distal radioulnar joint and impairment of nerve function, A clinical and experimental study. Acta orthop scand 108:1-153, 1967

18. Garg NK, Gaur S,Sharma S.Percutaneous autogenous bone marrow grafting in 20 cases of ununited fracture.Acta Orthop Scand 1993;64:671-2.

19. Garg NK, Gaur S. Percutaneous autogenous bone marrow grafting in congenital tibial pseudarthrosis. 3 Bone Joint Surg(Br)1995;77-B;830-1.

20. Gartland J J Evaluation of healed Colles fractures. JBJS 33 A: 895, 1951.

21. Geckler. E.O. Treatment of Comminuted CoIles fracture. 3 Int. Coll. Surg. 20:596, 1953

22. Goslings JC,Broekhuizen AH,Boxma H. Three dimensional dynamic external fixation of distal radial fractures .A prospective study. Injury 1999 Aug ;30(6);421- 30

23. Greg Sommerkamp T. Dynamic external fixation of unstable fractures of the distal part of the radius JBJS 76A August, 1994.

24. Haddad M,Jocoby B,Snerum L,Hede J,Overgaard S. External fixation of distal radial fractures; 3 or 5 weeks of external fixation. Int Orthop 2000;24(4);224-6.

25. Handoll HH,Madhok R.Surgical interventions for treating distal radial fractures in adults.ACPJ Club 2002 May-Jun,136(3);112.

26. Herrera M,Chapman CB,Roh M.Strauch RJ:Rosenwasser MP. Treatment of unstable distal radius fractures with cancellous allograft and external fixation. J Hand Surg (Am) 1999Nov,24(5);1269-78.

27. Higgins TF,Dodds SD,Wolfe SW.A biomechanical analysis of fixation of intraarticular distal radial fractures with calcium phosphate bone cement] Bone Joint Surg Am 2002 Sept.,84-A(9);1579-86.

28. Jerry. L Knirk and Jesse. B. Jupiter. Intra-articular fractures of the distal end of radius in young adult. JBJS.65 A: June 1986.

29. Jenkins NH, 1989. The unstable Colles fracture J. Hand surgery (Br) 1989 May 14(2) 149-54.

30. Joosten U,Joist A,Frebel T,Rieger H. The treatment of unstable fractures of the distal radius using a bridging external fixator.Results from long term evaluation. Chirurg 1999 Nov;70(11);1315-22.

31. Joshi. B.B. Hand and trauma-skeletal and soft tissue stabilisation. Joshi's external stabilisation system-manual.

32. Jupiter JB. Complex articular fractures of distal radius; dassification and management. J Am Acad Orthop Surg 1997 May; 5(3);119-129.

33. Kaempffe F.A. External Fixation for distal radius fractures- adverse effects of excess distraction. Am Journ of Orthopaedics 25(3):205-9. March 1996.

34. Krishnan J,Chipchase LS,Slavotinek J. Intraarticular fractures of distal radius treated with metaphyseal external fixation.Early clinical results ] Hand Surg (Br) 1998 ]un;23(3);396-9.

35. Ladd AL,Pliam NB. The role of bone graft and alternatives in unstable distal radius fracture treatment. Orthop Clin North Am 2001 Apr,32(2);337-51.

36. Udstorm A. Fractures of the distal end of radius- A clinical and statistical Study of end results. Acta Orthop. Scand Suppl. 91: 1-118, 1959.

37. Loeibig TG, Bathe, Anderson DD. Correlation of wrist ligamentotaxis with carpal distraction implications for external fixation J. Hand surgery American Nov 22(0:1052-6, 1997.

38. Low CK,Liau KH,Chew WY.Results of distal radial fractures treated by intra focal pin fixation.Ann Acad Med Singapore 2001Nov.

Dr Biju S

Assistant Professor in Orthopaedics,

Govt Medical College, Thiruvananthapuram

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Call For Paper Volume 12 Issue 10 November 2024

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Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles