Distal Radius External Fixation
synonyms:
Distal Radius External Fixation CPT
Distal Radius External Fixation Indications
- Open distal radius fracture
- Displaced distal radius fracture
Distal Radius External Fixation Contraindications
- Medically unstable patient
Distal Radius External Fixation Alternatives
- ORIF
- CRPP
- Splint / Casting
Distal Radius External Fixation Pre-op Planning
- Spanning external fixation limits restoration of volar and is associated with increased complications as compared to non-spanning external fixation (McQueen, JBJSB, 1998)
- Consider bone grafting to accelerate bone healing and/or supplementation with internal or K-wire fixation
- Distal Radius Case Card.
Distal Radius External Fixation Technique
- Sign operative site.
- Pre-operative antibiotics, +/- regional block.
- General endotracheal anesthesia
- Supine position with radiolucent hand table. All bony prominences well padded.
- Tourniquet placed high on arm.
- Prep and drape in standard sterile fashion.
- Two 1-cm incisions over the dorsal radial aspect of the 2nd metacarpal base and radial shaft. Blunt dissection to metacarpal.
- Place 3-mm self-tapping half-pins at a 30°-45° angle dorsal to the frontal plane of the hand.
- 4-cm skin incision10 cm proximal to the wrist joint.
- Dissection down to the radius between the extensor carpi radialis longus and brevis tendons.
- Protect the radial nerve.
- Insert towh 3-mm half-pins (1.5 cm apart) at a 30° angle dorsal to the frontal plane of the forearm.
- Confirm pin placement fluoroscopically.
- Apply clamps and bars per manufacture specifications to construct frame.
- Consider augmentation with bone graft, internal fixation, K-wires as indicated.
- Irrigate.
- Close proximal incision.
Distal Radius External Fixation Complications
- Malunion
- Nonuion
- Infection / Pin tract infection
- Arthrofibrosis
- Finger stiffness
- Tendon rupture
- Compartment Syndrome
- CRPS
- risks of surgery including but not limited to: malunion, nonunion, stiffness, CRPS, nerve or vascular injury, painful hardware, loss of fixation, tendon injury, infection, arthritis, incomplete relief of pain, incomplete return of function and the risks of anesthesia including heart attack, stroke, and death.
Distal Radius External Fixation Follow-up care
- Post-op: Volar plaster splint. Elevation, NWB. Active and passive finger ROM.
- 7-10 Days: Discontinue splint. Clean cutaneous/pin interface with peroxide BID. Active and passive finger ROM.
- Pin-Site Care: there is no significant difference in the incidence of pin-site infection regardless of pin-site care (dry dressings, peroxide, or chlorhexidine impregnated discs). (Egol KA, JBJS 2006; 88A:349)
- 6 Weeks: Remove Ex fix. Consider short arm cast / removeable splint. Active and passive finger ROM.
- 3 Months: Consider occupational therapy if wrist stiffness prevails. Sport specific rehab.
- 6 Months: Return to full activities / sport.
- 1Yr: F/U xrays, assess outcome.
Distal Radius External Fixation Outcomes
Distal Radius External Fixation Review References
°
|
