Results of combined internal and external fixation for the treatment of severe AO-C3 fractures of the distal radius.

Combined internal and external fixation for distal radius fractures has been previously reported, but the indications, technique, and results are not defined. This study reviews an experience with a specific surgical strategy for the treatment of a homogeneous population of AO-C3 fractures of the distal radius. The technique is composed of combined palmar and dorsal surgical approaches for open reduction and internal fixation of fracture fragments after neutralizing the wrist with a rigid external fixator. Thirteen fractures in 12 patients were followed an average of 27 months. Wrist motion averaged 60 degrees of flexion and 45 degrees of extension. The injured extremities had a mean grip strength that was 83% of the uninjured side. Follow-up x-ray films showed a dorsal tilt of 1 degree, radial inclination of 18 degrees, and radial length of 12 mm. Using the rating system of Green and O'Brien, the results were excellent or good in 10 wrists. The results indicate that this surgical strategy, though technically demanding, can be successfully used in this specific subset of difficult to treat distal radius fractures.