Compound distal radius fracture: stabilised with Hoffman II External Fixator
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Professional Guidelines Included
Learn the Compound distal radius fracture: stabilised with Hoffman II External Fixator surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Compound distal radius fracture: stabilised with Hoffman II External Fixator surgical procedure.
Distal radius fractures are a common injury and there is no agreed consensus on the best treatment method. The Cochrane review “Surgical interventions for treating distal radius fractures in adults” was withdrawn in 2009 due to its size and complexity. There is however another Cochrane review covering some of this ground titled “External fixation versus conservative treatment for distal radial fractures in adults”. The authors of this suggest that, allowing for the limitations of the available studies, external fixation augmented with percutaneous pin fixation has better radiographic outcomes and may have better functional outcomes when compared with cast immobilisation.
The majority of orthopaedic surgeons and hand surgeons would tend to use internal fixation in preference to external fixation although there is a paucity of evidence to support this. There would probably be little disagreement about using a wrist-spanning external fixator for open fracture-dislocations of the radio-carpal joint. Non-bridging external fixators are typically used for extra-articular fractures or for stabilising extra-articular corrective osteotomies.
In my practice for a displaced closed distal radius fracture where a closed reduction is possible, I would treat this with manipulation under anaesthetic and K-wire stabilisation (MUA + K-wires). When a closed reduction cannot be achieved, then I would use open reduction internal fixation (ORIF). For open fractures, my decision for the method of treatment is determined by the degree of wound contamination. In contaminated wounds from high energy injuries (i.e. there is a broken bone within a significant soft tissue injury) I would initially apply a spanning external fixator. This will often require conversion to a formal open reduction and internal fixation. Initially this allows the soft tissues to either improve or declare themselves as non-viable prior to open surgery. In low energy fractures that are only mild-moderately contaminated, I feel with a thorough debridement and irrigation open reduction internal fixation is a safe and definitive strategy.
Open fractures should be managed according to the British Orthopaedic Association Standard for Trauma which sits on the BOA site and the guidelines section of this technique.
The principles for the management of open fractures include:
- Combined Orthoplastic care
- Intravenous antibiotics within 1 hour
- Remove gross contamination (no mini-washout); photograph; saline soaked dressing
- Realign a deformed limb and splint (neurovascular assessment both pre- and post-reduction)
- Debridement immediately for highly contaminated wounds (agricultural, sewage, aquatic)
- Debridement within 12 hours for high energy open fractures
- Debridement within 24 hours for low energy open fractures.
The Hoffman II Compact External Fixator system is a modular system that is particularly suited for fracture management of the foot and hand & wrist. Its’ design allows many configurations and any deformity can be corrected in 3 planes. It can be used for both temporary and definitive fracture stabilisation.
Other techniques on OrthOracle that deal with the management of distal radial fractures are volar plating https://www.orthoracle.com/library/distal-radius-fracture-fixation-volar-approach-synthes-2-4-mm-variable-angle-locking-lcp/ ,K wiring https://www.orthoracle.com/library/distal-radius-fracture-manipulation-under-anaesthetic-mua-and-k-wire-fixation/ , and dorsal plating https://www.orthoracle.com/library/distal-radial-fracture-fixation-dorsal-approach-synthes-2-4mm-variable-angle-plating-system/
Handoll HH, Huntley JS, Madhok R. External fixation versus conservative treatment for distal radial fractures in adults. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006194
Author:Mr Ross Fawdington FRCS Ed (Tr & Orth)
Institution: Queen Elizabeth Hospital, Birmingham, UK.
0 of 14 questions completed
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
You must first complete the following:
0 of 14 questions answered correctly
Time has elapsed
Question 1 of 14
Which one of the following nerves is at risk when applying a wrist external fixator?CorrectIncorrect
Question 2 of 14
Which one of the following is the commonest age / sex to sustain a distal radius fracture?CorrectIncorrect
Question 3 of 14
Which one of the following is the commonest method for the treatment of distal radius fractures?CorrectIncorrect
Question 4 of 14
Which one of the following is correct regarding the time to surgery for intra-articular distal radius fractures according to the BOAST guidelines ?CorrectIncorrect
Question 5 of 14
Which one of the following is correct regarding the time to surgery for a high energy open distal radius fracture according to the BOAST?CorrectIncorrect
Question 6 of 14
Which one of the following is correct regarding the timing of the plastics opinion for compound wrist wound management?CorrectIncorrect
Question 7 of 14
Which one of the following is correct regarding the best method of irrigation?CorrectIncorrect
Question 8 of 14
Which of the following is correct regarding the angle of insertion of the external fixator half pins?CorrectIncorrect
Question 9 of 14
Which one of the following is correct regarding the half pin diameters that the pin clamp can accept?CorrectIncorrect
Question 10 of 14
Which one of the following is correct regarding the incidence of major complications when using non-bridging external fixators?CorrectIncorrect
Question 11 of 14
Which one of the following is the correct incidence of Extensor Pollicis Longus (EPL) tendon rupture in nondisplaced distal radius fractures?CorrectIncorrect
Question 12 of 14
Which one of the following is correct regarding the effected digits in carpal tunnel syndrome?CorrectIncorrect
Question 13 of 14
Which one of the following is correct regarding the relationship of the ulnar artery and nerve?CorrectIncorrect
Question 14 of 14
Which one of the following is the correct muscle that is attached to the mid-shaft of the radius?CorrectIncorrect