Principles of external ®xation and supplementary techniques in distal radius fractures T. Gausepohl*, D. Pennig, K. Mader Department of Trauma Surgery, Hand and Reconstructive Surgery, St. Vinzenz-Hospital, Merheimer Straûe 221±223, D-50733 Cologne, Germany Abstract External ®xation for fractures of the distal radius has been used for almost 80 years. The main objective is to gain reduction and maintain the reduction throughout the treatment period. Several ®xator concepts are available and selection is based on the complexity of the injury to be treated as well as the surgeon's experience. Periarticular application of the ®xator with immediate use of the wrist joint is recommended whenever possible. For intra-articular fractures, transarticular application is advisable. External ®xtion in complex fractures has to be supplemented by bone grafting, ®xation wires and stabilization of the radioulnar joint. Associated injuries in distal radius fractures need to be identi®ed and treated. The possible complications of external ®xation and the means to prevent them are discussed. External ®xation of the distal radius has found its place as an established method in treating certain types of this common fracture. # 2000 Elsevier Science Ltd. All rights reserved. 1. Introduction The distal radius fracture was clinically diagnosed in 1814 by Colles [1], who described this entity in a jour- nal published in Edinburgh. However, even today, treatment remains controversial. The treatment options for the displaced distal radius fracture are closed re- duction with plaster cast immobilisation [2], pins and plaster [3], open reduction and internal ®xation [4], closed reduction [5] and, more recently, augmented external ®xation [6±11]. One of the reasons for this controversy is the heterogeneous patient population in which the fracture occurs. In younger patients (those under 40 years of age), considerable forces are necess- ary to cause this fracture, which is de®ned as being localised within 3 cm of the distal end of the radius [12,13]. There is a sharp increase in incidence above the age of 30 years, which apparently is associated with postmenopausal and age-related osteopenia. In the USA and northern Europe, this fracture is the most common one in women under 75 years old [14± 16]. Studies looking at radial bone density failed to demonstrate signi®cant reductions in bone density when radius fracture patients were compared with age- matched control subjects [14]. Sparado et al. [7] showed that both the cortical and the trabecular bone contribute to the overall strength of the osteopenic dis- tal radius. In eect, both the cortical comminution and the metaphyseal cancellous bone defect may contribute to the inherent instability of a distal radius fracture. Looking at the epidemiology of distal radius frac- tures, the Reykjavik, Iceland, study [3] showed that 249 fractures in patients over 15 years of age occurred within a total at risk population of 100,154. The inci- dence pattern here is similar to those reported in other Nordic studies. The study analyzed the distribution of distal radius fractures with regard to the social en- vironment (Table 1). With more than a half of the radius fracture patients being employed, the economic implications become evident. 2. Development of external ®xation in the distal radius Lambotte in 1907 [17] was the ®rst to realize that in certain cases a fracture of the distal radius required an operative approach. External ®xation was introduced Injury, Int. J. Care Injured 31 (2000) 56±70 0020-1383/00/$ - see front matter # 2000 Elsevier Science Ltd. All rights reserved. PII: S0020-1383(99)00264-8 www.elsevier.com/locate/injury * Corresponding author.