TREATMENT OF UNSTABLE FRACTURES OF THE DISTAL RADIUS BY EXTERNAL FIXATION

The Roger Anderson external fixator was used in the treatment of unstable fractures of the distal radius in 52 patients, and the results evaluated after a follow-up averaging 58 months. The indications for its use were failure to maintain adequate closed reduction using plaster, and instability of the fracture as determined by the initial radiographs. Our radiological criteria for instability included dorsal angulation of more than 200, fractures involving the joint, radial shortening of more than 10 mm, and severe dorsal comminution. Using the Lucas modification of the Sarmiento demerit point-rating system, we found that 46 patients (89%) had good or excellent results and six (1 1 %) were classified as fair. There were no poor results. Seven patients (14%) developed complications. None of these affected the long-term results except in one elderly woman where the pins loosened and had to be removed. Although the optimum treatment of Colles ’ fractures remains controversial, functionally good results can be expected in most patients treated by closed reduction and plaster immobilisation. There are some fractures of the distal end of the radius, however, where results are con-sistently poor. In particular, badly comminuted and/or intra-articular fractures present specific problems i