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ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 46-50

Distal radius fractures with unstable distal radioulnar joint treated by volar plate: A comparative study of immobilization versus early mobilization


Department of Orthopaedics, Govt. Medical College, Kannur, Pariyaram Kerala, India

Correspondence Address:
Dr. Subraya Bhat Kuloor
Department of Orthopaedics, Govt. Medical College, Kannur, Pariyaram - 670 503, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joas.joas_6_19

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BACKGROUND: Instability of distal radioulnar joint (DRUJ) following distal radius fracture is a treatment enigma with few options and uncertain outcome. Different studies have been conducted in this regard which came out with contradicting results. The aim of this study was to analyze whether immobilization of unstable DRUJ with above-elbow cast for 6 weeks has any advantages versus immobilization for 3 weeks similarly after anatomical fixation with volar plates. MATERIALS AND METHOD: We conducted a prospective study on patients with unstable distal radius fractures treated by open reduction with volar buttress plate from 2013 to 2016. Patients were grouped into Groups 1 and 2 depending on the postoperative immobilization protocol (each group with 21 patients). Group 1 patients were immobilized with above-elbow cast for 3 weeks and Group 2 patients for 6 weeks. Results were compared using wrist range of movements, patient-oriented Patient-Rated Wrist Evaluation (PRWE) and physician-based Sarmiento modified Gartland–Werley (GW) demerit scoring. All patients were evaluated for the persistence of DRUJ instability. RESULTS: Demographic data were comparable between the groups. AO type C fracture (67%) was common in both groups. The range of movements was comparable in both groups (P > 0.11). There was no statistically significant difference found in GW and PRWE scoring (P > 0.05). There were two patients with unstable DRUJ with decreased radial height and positive ulnar variance who needed further treatment. CONCLUSION: Prolonged immobilization (6 weeks) contributed no extra benefit when DRUJ is well reduced with anatomical fracture fixation. The instability recovered with healing of ligamentous injuries and fractures after stabilization of unstable bony fragments with surgical fixation of distal radius fracture.


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