Fijación externa en la fractura distal del radio

Alejandro Álvarez López, Yenima García Lorenzo

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Resumen

Fundamento: la fractura del extremo distal del radio es una enfermedad traumática frecuente, el tratamiento de esta afección puede ser conservador o quirúrgico, en relación a este último la fijación externa es uno de los más empleados por sus ventajas.
Objetivo:
profundizar y actualizar los conocimientos sobre pacientes que sufren de fractura del extremo distal del radio, debido a su alta incidencia en los servicios de urgencia.
Métodos:
la búsqueda de la información se realizó en el periodo de un mes (octubre) y se emplearon las siguientes palabras: fractures of the distal radius y wrist fracture, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 1507 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 55 citas seleccionadas para realizar la revisión, 53 de ellas de los últimos cinco años donde se incluyeron siete libros.
Desarrollo:
se describen los criterios radiográficos de reducción aceptable, así como las indicaciones quirúrgicas generales y en específico de la fijación externa. Se hace referencia a los factores que afectan el tratamiento. Se describen los tipos de fijación externa e indicaciones específicas de cada una. Se plasman los factores predictivos de inestabilidad, las complicaciones y las principales ventajas y desventajas de la fijación externa al compararla con la fijación interna mediante láminas volares.
Conclusiones: la fijación externa es un método efectivo para el tratamiento de pacientes con fractura del extremo distal del radio, ofrece ventajas como su fácil aplicación, logra una buena reducción y estabilidad de manera independiente de los dos tipos de fijación, que tienen indicaciones muy específicas, su uso implica un bajo índice de complicaciones entre las que se destaca la infección en el trayecto de los pines alambres. Por otra parte, los resultados funcionales a largo plazo son muy similares a los logrados por la fijación interna con placas volares.
DeCS: FRACTURAS DEL RADIO/cirugía; FRACTURAS DEL RADIO/terapia; FIJADORES EXTERNOS; RESULTADO DEL TRATAMIENTO; LITERATURA DE REVISIÓN COMO ASUNTO.

Palabras clave

FEDR- Fractura del extremo distal del radio FE- Fijación externa

Referencias

Egol KA, Koval KJ, Zuckerman JD. Handbook of fractures. 5 th ed. Philadelphia: Wolters Kluwer; 2015.

Brogan DM, Richard MJ, Ruch D, Kakar S. Management of severely comminuted distal radius fractures. J Hand Surg Am. 2015 Sep;40(9):1905-14.

Sigurdardottir K. Epidemiology. En: Hove LM, editor. Distal radius fracture. Berlin: Springer Verlag; 2014. p. 37-44.

Rhee PC, Shin AY. Management of complex distal radius fractures: review of treatment principles and select surgical techniques. J Hand Surg Asian Pac Vol. 2016 Jun;21(2):140-54.

Han LR, Jin CX, Yan J, Han SZ, He XB, Yang XF. Effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures. Genet Mol Res. 2015 Mar;14(1):2912-19.

Tang P, Lee SK. Hand and wrist trauma. En: Cannada LK, editor. Orthopaedic knowledge update: 11. Illinois: Am Acad Orthop Surg; 2014. p. 419-32.

McQueen MM. Fractures of the distal radius. En: Court Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, editors. Rockwood and Green's Fractures in Adults. 8 th ed. Philadelphia: Wolters Kluwer; 2015. p. 1057-1120.

Fernandez DL, Jupiter JB. Fractures of the distal radius. New York: Springer Verlag; 1996.

Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014 Oct-Dec;3(4):325-32.

Hammert WC, Kramer RC, Graham B, Keith MW. AAOS appropriate use criteria: treatment of distal radius fractures. J Am Acad Orthop Surg. 2013 Aug;21(8):506-9.

Bales JG, Stern PJ. Treatment strategies of distal radius fractures. Hand Clin. 2012 May;28(2):177-84.

Kuo LC, Yang TH, Hsu YY, Wu PT, Lin CL, Hsu HY, et al. Is progressive early digit mobilization intervention beneficial for patients with external fixation of distal radius fracture? A pilot randomized controlled trial. Clin Rehabil. 2013 Nov;27(11):983-93.

Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am. 2014 Jul;39(7):1280-6.

Foldager Jensen AD. The clinical dilemma: nonoperative or operative treatment. En: Hove LM, editor. Distal radius fracture. Berlin: Springer Verlag; 2014. p. 109-13.

Jeudy J, Steiger V, Boyer P, Cronier P, Bizot P, Massin P. Treatment of complex fractures of the distal radius: a prospective randomized comparison of external fixation 'versus' locked volar plating. Injury. 2012 Feb;43(2):174-9.

Yoon A, Grewal R. Management of distal radius fractures from the North American perspective. Hand Clin. 2012 May;28(2):135-44.

Cui Z, Yu B, Hu Y, Lin Q, Wang B. Dynamic versus static external fixation for unstable distal radius fractures: an up-to-date meta-analysis. Injury. 2012 Jul;43(7):1006-13.

Farah N, Nassar L, Farah Z, Schuind F. Secondary displacement of distal radius fractures treated by bridging external fixation. J Hand Surg Eur Vol. 2014 May;39(4):423-8.

Kulshrestha V, Roy T, Audige L. Dynamic vs static external fixation of distal radial fractures: a randomized study. Indian J Orthop. 2011 Nov;45(6):527-34.

Simic PM, Placzek JD. Distal radius fracture. En: Stannard JP, Schmidt AH, Kregor PJ, editors. Surgical Treatment of Orthopaedic Trauma. New York: Thieme; 2007. p. 364-86.

Qiu WJ, Li YF, Ji YH, Xu W, Zhu XD, Tang XZ, et al. The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities. Sci Rep. 2015 Nov;5:15318.

Shaftel ND, Posner MA. Commentary on Farah N et al. Secondary displacement of distal radius fractures treated by bridging external fixation. J Hand Surg Eur Vol. 2014 May;39(4):429-30.

Williksen JH. Closed reduction and external fixation of unstable distal radius fractures. En: Hove LM, editor. Distal radius fracture. Berlin: Springer Verlag; 2014. p. 129-37.

ur Rahman O, Khan MQ, Rasheed H, Ahmad S. Treatment of unstable intraarticular fracture of distal radius: POP casting with external fixation. J Pak Med Assoc. 2012 Apr;62(4):358-62.

Obert L, Rey PB, Uhring J, Gasse N, Rochet S, Lepage D, et al. Fixation of distal radius fractures in adults: a review. Orthop Traumatol Surg Res. 2013 Apr;99(2):216-34.

Raduan Neto J, Moraes VY de, Gomes Dos Santos JB, Faloppa F, Belloti JC. Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol. BMC Musculoskelet Disord. 2014 Mar;15:65.

Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PR. External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury. 2013 Apr;44(4):409-16.

van Schaik DE, Goorens CK, Wernaers P, Hendrickx B, Scheerlinck T, Goubau JF. Evaluation of current treatment techniques for distal radius fractures among Belgian orthopaedic surgeons. Acta Orthop Belg. 2015 Jun;81(2):321-6.

Mauffrey C, Seligson D, Yerasimides J. External fixation about the wrist and the forearm. En: Seligson D, editor. External fixation in Orthopedic Traumatology. London: Springer Verlag; 2012. p. 107-19.

Cowie J, Anakwe R, McQueen M. Factors associated with one-year outcome after distal radial fracture treatment. J Orthop Surg (Hong Kong). 2015 Apr;23(1):24-8.

Navarro CM, Pettersson HJ, Enocson A. Complications after distal radius fracture surgery: results from a Swedish nationwide registry study. J Orthop Trauma. 2015 Feb;29(2):e36-42.

Gu WL, Wang J, Li DQ, Gong MZ, Chen P, Li ZY, et al. Bridging external fixation versus non-bridging external fixation for unstable distal radius fractures: a systematic review and meta-analysis. J Orthop Sci. 2016 Jan;21(1):24-31.

Hansen TB, Snerum L. Radiolucency around external fixation pins in distal radius fractures is not a part of a deep infection. J Hand Surg Eur Vol. 2013 Oct;38(8):905-6.

Moradi A, Ebrahimzadeh MH, Jupiter JB. Intra-articular fractures of the distal radius: bridging external fixation in slight flexion and ulnar deviation along articular surface instead of radial shaft. Tech Hand Up Extrem Surg. 2014 Mar;18(1):41-50.

Siripakarn Y, Suntarapa T, Chernchujit B. Multipurpose external fixation for unstable comminuted intraarticular fracture of distal radius. J Med Assoc Thai. 2013 Apr;96(4):446-55.

Walenkamp MM, Bentohami A, Beerekamp MS, Peters RW, van der Heiden R, Goslings

JC, et al. Functional outcome in patients with unstable distal radius fractures, volar

locking plate versus external fixation: a meta-analysis. Strategies Trauma Limb Reconstr. 2013 Aug;8(2):67-75.

Chen YX, Zheng X, Shi HF, Wangyang YF, Yuan H, Xie XX, et al. Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable. BMC Musculoskelet Disord. 2013 Jun;14:186.

Natoli RM, Baer MR, Bednar MS. Conversion of external fixation to open reduction and internal fixation for complex distal radius fractures. Orthop Traumatol Surg Res. 2016 May;102(3):339-43.

Kumbaraci M, Kucuk L, Karapinar L, Kurt C, Coskunol E. Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures. Eur J Orthop Surg Traumatol. 2014 Feb;24(2):173-8.

Williksen JH, Frihagen F, Hellund JC, Kvernmo HD, Husby T. Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures: a randomized, controlled study. J Hand Surg Am. 2013 Aug;38(8):1469-76.

Jorge Mora AA, Cecilia López D, Rodríguez Vega V, Suárez Arias L, Andrés Esteban E, Porras Moreno MA, et al. Comparison between external fixators and fixed-angle volar-locking plates in the treatment of distal radius fractures. J Hand Microsurg. 2012 Dec;4(2):50-4.

Safdari M, Koohestani MM. Comparing the effect of volar plate and external fixators on outcome of patients with intra-articular distal radius fractures: a clinical trial. Electron Physician. 2015 Jun;7(2):1085-91.

Wang J, Yang Y, Ma J, Xing D, Zhu S, Ma B, et al. Open reduction and internal fixation versus external fixation for unstable distal radial fractures: a meta-analysis. Orthop Traumatol Surg Res. 2013 May;99(3):321-31.

Mellstrand Navarro C, Ahrengart L, Törnqvist H, Ponzer S. Volar locking plate or external fixation with optional addition of K-wires for dorsally displaced distal radius fractures: a randomized controlled study. J Orthop Trauma. 2016 Apr;30(4):217-24.

Roh YH, Lee BK, Baek JR, Noh JH, Gong HS, Baek GH. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. J Hand Surg Am. 2015 Jan;40(1):34-41.

Shukla R, Jain RK, Sharma NK, Kumar R. External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes. J Orthop Traumatol. 2014 Dec;15(4):265-70.

Lee DJ, Elfar JC. External fixation versus open reduction with locked volar plating for geriatric distal radius fractures. Geriatr Orthop Surg Rehabil. 2014 Sep;5(3):141-3.

Curtin CM, Hernandez Boussard T. Readmissions after treatment of distal radius fracture. J Hand Surg Am. 2014 Oct;39(10):1926-32.

Li-hai Z, Ya-nan W, Zhi M, Li-cheng Z, Hong-da L, Huan Y, et al. Volar locking plate versus external fixation for the treatment of unstable distal radial fractures: a meta-analysis of randomized controlled trials. J Surg Res. 2015 Jan;193(1):324-33.

Bajwa AS, Rammappa M, Lee L, Nanda R. Treatment of unstable distal radius fracture: non-invasive dynamic external fixator versus volar locking plate-functional and radiological outcome in a prospective case-controlled series. SICOT J. 2015 Dec;1:34.

Williksen JH, Husby T, Hellund JC, Kvernmo HD, Rosales C, Frihagen F. External fixation and adjuvant pins versus volar locking plate fixation in unstable distal radius fractures: a randomized, controlled study with a 5-year follow-up. J Hand Surg Am. 2015 Jul;40(7):1333-40.

Fakoor M, Mohammadhoseini P. Displaced intra-articular fractures of the distal radius: open reduction with internal fixation versus bridging external fixation. Trauma Mon. 2015 Aug;20(3):e17631.

Chilakamary VK, Lakkireddy M, Koppolu KK, Rapur S. Osteosynthesis in distal radius fractures with conventional bridging external fixator; tips and tricks for getting them right. J Clin Diagn Res. 2016 Jan;10(1):RC05-8.

Zhang Q, Liu F, Xiao Z, Li Z, Wang B, Dong J, et al. Internal versus external fixation for the treatment of distal radial fractures: a systematic review of overlapping meta-analyses. Medicine (Baltimore). 2016 Mar;95(9):e2945.

Ma C, Deng Q, Pu H, Cheng X, Kan Y, Yang J, et al. External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients. Bone Res. 2016 Jun;4:16017.

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