Introduction : External fixation is a good alternative method for fractures of the distal end of radius that are not manageable for closed treatment. It is a simple technique, and has proved to be safe and effective in our experience.

Material and Methods: We present 25 patients with 26 fractures of the distal end of radius (age 32 to 85, avg 57 yrs) which were treated by external fixation during the last 4 years. Eight fractures were in polytrauma patients, 16 were unstable and one patient had bilateral fractures. According to Frykman classification 2 were in type II, 5 in type IV, 2 in type V, 5 in type VI, 4 in type VII and 8 in type VIII.

The time of surgical treatment since the date of fracture ranged from 9–15 days (avg 12 days) .We used Pennig’s fixator in 22 cases and Citieffe fixator in 4 cases.

Results: All patients were followed up for 8 to 42 months (mean 27, 7). Clinical union was established at an average of 6.5 weeks following the fracture. There was one infection of the distal pins, 2 cases with algodystrophy, but no malunion. For assessment of the anatomical result we used the Sarmiento and Latta modification of the Lidstrom classification: 16/26 (61.5%) were excellent, 8/26 (30.7%) good, 1/26 (3,87%) fair and 1/26 (3.87%) poor.

Conclusion: In comminuted, badly displaced fractures of the distal end of radius, the upper extremity following initial closed manipulation and application of plaster is characterized by a decrease in finger mobility, oedema, and large mass of bandaging. Instability of the fracture nad poor result is expected as soon as the oedema subsides. Alternatively, an external fixator is applied after remission of the edema and before two weeks from the fracture date, so to the fracture is easily reducible. With the delay in fixator application we avoid reduction difficulty and pin infection as the oedema has subsided, we have time to explain everything to the patient and organize the operation . This delay in the application of external fixation in distal fractures of the radius is favored in our department because of the low complication rate, excellent or good (92%) functional results, easy and safe approach.

Distal radius fractures are very common and they often require surgical intervention to prevent long-term complications. We noticed that several patients were being managed non-operatively for prolonged periods of time, when ultimately surgical fixation was inevitable. Delayed fixation of these injuries results in prolonged immobilisation, repeat fracture clinic attendances, callous formation, poor soft tissues, stiffness and union. Our aim was to analyse the time to fixation of distal radius fractures at our hospital using a standard volar locking plate. Between December 2010 and September 2011, our study population included all patients who underwent surgical fixation for a distal radius fracture at Royal Derby Hospital. All fractures were fixed using a volar locking plate. Data collected included date of injury, fracture clinic attendances, date listed for surgery and date of surgery. There were 100 patients who underwent surgical fixation, with a mean age of 63.6 years (17 to 91). The mean date from injury to fixation was 7.7 days (range 0 to 23). 82% of fractures were operated on within 14 days, and 98% were fixed within 21 days. We accept that our study does have some limitations; this includes patients who are unwilling to accept surgery at their initial consultation. Distal radius fractures have a strong tendency to revert back to their original configuration; hence we suggest that a decision to operate should ideally be made at the one-week fracture clinic appointment. This avoids the difficulties and complications associated with delayed surgical intervention. Stability, displacement, reduction and patient factors should all be taken into account

The June 2014 Trauma Roundup³⁶⁰ looks at: BMP use increasing wound complication rates in trauma surgery; can we predict re-admission in trauma?; humeral bundle nailing; how best to treat high-angle femoral neck fractures?; hyperglycaemia and infection; simultaneous soft-tissue and bony repair in terrible triad injuries; metaphyseal malunion in the forearm leading to function restrictions; delayed fixation of the distal radius: not a bad option; and fasciotomies better with shoelaces