Arch Hand Microsurg 2018; 23(3): 166-174  
Functional Outcome of the Wrist according to Degree of Distraction with External Fixation in the Treatment of Distal Radius Fracture
Tae Hoon Roh, Yun Moon Jeon, Yeop Na, Tong Joo Lee
Department of Orthopedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
Correspondence to: Tong Joo Lee
Department of Orthopedic Surgery, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea
TEL: +82-32-890-3043, FAX: +82-32-890-3047, E-mail:
Received: April 10, 2018; Revised: July 24, 2018; Accepted: July 24, 2018; Published online: September 1, 2018.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: This study aimed to evaluate the relation between the degree of wrist joint distraction and postoperative restoration of joint function after performed external fixation with distraction of wrist joint in distal radius fracture.
Methods: This study was conducted retrospectively on 55 patients who underwent reduction using external fixation for distal intra-articular radius fracture from January 2007 to December 2014. The degree of pre- and post-operative distraction was measured radiographically using the carpal height ratio (CHR). For postoperative functional assessment, range of motion of the wrist, Gartland Werley classification, grip strength, and pinch strength were measured.
Results: In the functional assessment based on the Gartland Werley classification, excellent was reported by 31 patients, good; 16 patients, fair; 8 patients, and poor; 0 patients. The mean CHR was 0.519 preoperatively and 0.565 immediately after surgery. The mean postoperative CHR of excellent group was 0.581, demonstrating better clinical outcome in distraction than other groups. Eight case of joint stiffness was manifested when CHR value was lower than 0.54 and only 1 case of joint stiffness was manifested when CHR value was higher than 0.54, showing a tendency for lower incidence of joint stiffness when distracted over 0.54 of CHR.
Conclusion: External fixation after sufficient distraction of the wrist joint produced an excellent outcome in the functional assessment. The better the prognosis in the Gartland Werley classification, the higher the CHR and the group with a CHR greater than 0.54 immediately after surgery showed less joint stiffness than the lower group.
Keywords: Radius fractures, External fixators, Distraction

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