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Pilon Fractures of the WristDisplaced intra-articular fractures of the distal radiusFrom Park Hospital, Davyhulme and Hope Hospital, Salford Correspondence: R. M. Tillman, F.R.C.S., Department of Orthopaedic Surgery, Royal Preston Hospital, Sharoe Green Lane, Preston, Lancs. PR2 4HT.
22 patients who sustained high energy wrist injuries are reported. These complex injuries resulted in articular disruption of the distal radius. Associated injuries included scapho-lunate dissociation (18%), central die-punch injuries (14%), ulnar fractures (41%) and diastasis at the distal radio-ulnar joint (23%). Nine fractures (41%) were open and almost a third of patients had other skeletal injuries. All patients were treated by external fixation and reviewed after a mean follow-up of 2
Journal of Hand Surgery (British and European Volume), Vol. 17, No. 1,
63-68 (1992) |
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years. There were no excellent results and only ten good ones (45%). The mean functional impairment was 32%. The external fixator was effective in maintaining extra-articular alignment, but not in ensuring accurate reduction of the articular surface. Residual incongruity of the joint surface was an adverse prognostic feature. All five patients (22%) with an articular step of more than 2 mm. developed symptomatic arthritis. Failure to restore the joint line did not account for all the unsatisfactory results; persistent scapho-lunate dissociation and problems at the distal radio-ulnar joint were also important.