Severe fractures of the distal radius: effect of amount and duration of external fixator distraction on outcome.

Although severe intra-articular fractures of the distal radius are often treated with external fixation/distraction, little attention has been devoted to the amount and duration of fixator distraction required to maximize outcome. To determine these effects, we conducted a retrospective study of 26 patients whose primary treatment was external fixation/distraction. Patients were evaluated by chart review, questionnaire, x-ray films, and physical examination an average of 104 weeks after injury. The carpal height index was used to quantify distraction. Scores for pain, function, wrist motion, and grip strength and the total score were adversely affected in proportion to the increase in carpal height index by distraction. Outcome was adversely affected as the duration of distraction increased. Motion scores were affected most. Overall, patients recovered at least 75% of motion and grip strength, and 85% attained New York Orthopedic Hospital grades of good or excellent. These are the first data to show that there are potential adverse effects from increasing amounts of distraction and prolonged use of the external fixator.