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Complex Fragmentation of the Articular Surface of the Distal Radius: Management With Small Kirschner Wires and Bone Graft

Pillukat, Thomas MD*; Schädel-Höpfner, Michael MD; Prommersberger, Karl-Josef MD*

Techniques in Hand & Upper Extremity Surgery: March 2012 - Volume 16 - Issue 1 - p 1–4
doi: 10.1097/BTH.0b013e318225473e
Techniques

Severe intra-articular fractures of the distal radius with comminuted, displaced, and malrotated fragments are the most challenging fracture patterns. Reconstruction faces 3 major problems: fixation of fragments that are too small for stabilization by standard plates or screws, restoration of substantial cartilage loss in the articular surfaces, and extended metaphyseal/subchondral bony defects. For addressing these problems, a strategy is reported, by applying small, subchondrally placed Kirschner wires for the realignment of the articular surfaces, temporary inlay of a silicone foil in case of lost articular cartilage, and iliac crest bone grafting for bony defects. Stability is further augmented by buttress plates. This study reviews the historical perspective, indications, technique, complications, and rehabilitation of this strategy.

*Klinik für Handchirurgie, Salzburger Leite 1, D 97616 Bad Neustadt an der Saale

Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf Moorenstr. 5, Düsseldorf, Germany

Conflicts of Interest: The authors report no conflicts of interest.Address correspondence and reprint requests to Thomas Pillukat, MD, Klinik für Handchirurgie, Salzburger Leite 1, D 97616 Bad Neustadt an der Saale, Germany. e-mail: t.pillukat@handchirurgie.de

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved