Purpose The most common skeletal injury to the upper extremity is fracture of the distal radius. Unstable fractures require operative treatment with external fixator, percutaneous pins, or plates. External fixation can arrest shortening of the distal radius, but cannot prevent shortening entirely. Despite shortening after external fixation of distal radius fractures, patients rarely experience adverse outcomes. The purpose of this study was to determine the degree of shortening associated with externally fixated distal radius fractures and to correlate shortening with clinical outcomes.

Methods Sixty-two patients were identified who sustained distal radius fractures classified as Orthopaedic Trauma Association type C2, C3, or A3. All patients were treated with an external fixator plus pins, bone graft, and/or internal fixation. Data from sixty-one patients who completed final follow up (average time 31 months) were analyzed. Radiographic evaluations were used to determine the amount of shortening of the distal radius. Disability of Arm, Shoulder, and Hand (DASH) outcomes scores were collected to document the patients’ health-related quality of life.

Results All 61 patients sustained some degree of collapse ranging between less than 2 mm to 13 mm (average=2.7 mm). Thirty-four patients exhibited shortening of 2mm or less while 14 displayed 4mm or less of shortening. The remaining 13 patients had greater than 5mm of shortening of the distal radius. The average DASH score was 17. Of the 61 patients, 53 (87%) reported DASH outcomes scores of 25 or less, signifying satisfactory outcome. The worst DASH scores were associated with an increased number of fracture fragments and loss of motion in both extension and supination. Patients who underwent grafting with iliac crest bone exhibited shortening of less than 2mm of the distal radius and DASH scores of 15 points or less, indicating good overall outcomes. Using linear regression analysis, no statistically significant correlation was found between the degree of collapse and DASH scores.

Discussion Despite collapse of distal radius fractures treated by external fixation, patients did not exhibit significant functional impairment at follow up. The lowest level of disability was documented in patients who underwent autologous bone graft; these patients also had a lesser degree of shortening. However, no statistically significant correlation can be drawn between degree of collapse following external fixation of wrist fractures and impairment measured by the DASH outcome scale. These results suggest that clinical outcome is not dependent upon the amount of shortening in distal radius fractures.