Early Functional Outcomes After Closed Reduction With Pinning Versus Open Reduction Internal Fixation of Wrist Fractures

Inclusion criteria

• 18 years or greater
• Patient functions independently
• Dorsally displaced, extra-articular fracture (Colles' fracture); or simple intra-articular fracture with a single split between the scaphoid and lunate facets.
• Isolated injury (no other injuries).
• One of the following criteria:

Substantial initial displacement

• Greater than 20 degrees dorsal angulation of the articular surface on the lateral view.
• Greater than 100% loss of apposition.
• Greater than 5 millimeters of shortening by ulnar variance on the posteroanterior radiograph.
• Greater than 2 millimeters articular incongruity (step or gap).
• Both dorsal and volar comminution. Inadequate initial manipulative reduction
• Greater than 5 degrees of dorsal angulation of the articular surface on the lateral radiograph.
• Greater than 3 millimeters of radial shortening by ulnar variance on the posteroanterior radiograph.
• Greater than 2 millimeters articular incongruity.
• Bayonett apposition of the volar cortex.
• Less than 15 degrees of ulnarward inclination of the articular surface in the posteroanterior radiograph. Loss of reduction within 3 weeks of injury.
• Any of the following changes in alignment from the initial post- reduction radiographs qualify:

• 5 degrees or greater loss of palmar tilt of the articular surface on the lateral radiograph.
• 2 millimeters or greater loss of radial height by ulnar variance on the posteroanterior radiograph.
• 5 degrees or greater loss of ulnarward inclination of the articular surface of the distal radius on the posteroanteriorradiograph.
• 2 millimeters or greater articular incongruity.

Exclusion criteria

• More complex articular fractures (i.e. anything more than a simple sagittal split between the scaphoid and lunate facets).
• Volarly displaced fractures.
• Infirm patients.
• Patients that rely on others for basic functional activities.
• Open fractures
• Fractures associated with neurovascular injury.
• Fractures associated with major head, neurological, or visceral injuries that will inhibit the ability to participate in a structured exercise program.
• Associated musculoskeletal injuries to the same arm.