Early salvage reconstruction of severe distal radius fractures.

During an 8-year period from 1980 through 1988, 9 distal radius fractures could not be restored because of bone loss or extensive comminution and were, therefore, salvaged by early arthrodesis in 7 patients and Swanson silicone wrist arthroplasty in 2. At a mean of 3.7 years, 4 patients rated good, 2 satisfactory, and 3 poor according to a 100-point scoring system based on residual pain, motion, grip strength, and occupational recovery. Irreparable distal radial fractures with damage largely confined to the skeleton achieved satisfactory or good results. Poor results occurred when there was severe soft tissue damage, especially neurovascular injury, despite a successful skeletal reconstruction. When articular restoration could not be accomplished, early arthrodesis or arthroplasty resulted in wrist alignment, stability, and pain control, and optimized the opportunity for digital and upper extremity functional recovery.