Background: Fractures of distal radius are common injuries. Unstable distal radius fractures present a challenge to the treating orthopaedic surgeon. One of the therapeutic methods is Ilizarov hybrid external fixator. In this study short-term result of this method in a small group is reported.Methods: 18 consecutive patients with unstable fracture of distal radius were treated with non-bridging hybrid Ilizarov external fixator for 7 weeks. Clinical and radiological evaluation was performed at one and 7 days, and at 6 weeks and 6 months after surgery.Results: All fractures united but anatomic reduction was achieved in only 16 cases (90%). The achieved range of motion was: 80% flexion, 85% extension and 90% supination and pronation. Compared to the normal side, no extensor tendon injury and tendonitis of pin loosening occurred. Only 5 mild pin track infection was observed that resolved by findings of oral antibiotic therapy.Conclusion: The technique of hybrid non bridging external fixator is safe and reliable option method for unstable intra and extra-articular distal radius fractures. It permits free wrist motion during treatment preventing joint stiffness.

Background: The value of external fixation in complex hand injuries is well established. Expenses and technical difficulties ofcommercial mini external fixator sets have led to the innovation of handmade external fixators. These fixators are used as versatilefacilities to treat certain hand fractures. Usually, these structures are made by k-wires crossed filled with cement plastic tube. However, these fixators have multiple deficiencies that should be addressed. Objectives: In this study, we described in detail the surgical technique of a handmade concrete like mini external fixator and reportits clinical use and results. Methods: Our handmade external fixator was applied for 52 patients with 56 fractures. Only 5% of the fractures were closed, noncomminutedextra-articular, and the other 51 fractures were more complex injuries. The mean follow up time was 9. 3 months. Atthe end of the follow up, radiologic and functional assessment (DASH: Disability of arm, shoulder and hand and TAM: Total activemotion) was evaluated. Results: All 56 fractures were united completely. None of the cases experienced pin loosening or reduction loss. Of the fractures, 8. 9% malunited due to fracture complexity. The mean dash score was 3. 76. TAM was excellent in 45% of the fractures; it was good in7% and fair in 4%. Conclusions: This type of handmade external fixator is simple, lightweight, and cheap. Furthermore, all implements are readilyavailable in most operating fields. The probability of loosening has been greatly diminished because of the concrete like structure. Easy and fast assembly and good clinical and functional results are the other advantages of this technique. Due to the less complicationand benefits, this technique could be used for many phalangeal and metacarpal fractures with confidence.

Introduction: Fractures of distal radius are common in adulthood and treatment of these fractures especially displaced intraarticulars is controversial. External fixation is one of treatments for these fractures. This study was designed to evaluate the results of distal radial intraarticular fractures treatment with external fixator (transfixation). Materials and Methods: This is a study with no control in which 26 patients (30 fractures) with distal radial fractures (universal type IV) where selected by convenience method. Closed reduction and external fixator application for 6 weeks was performed in all patients. Patients were followed for one year.Results: There were 26 patients (4 bilateral cases) including 24 males and 2 females. Their average age was 28±5 years. Average follow up time was 8 months (6 to 20 months). Clinical and radiographic union occurred in all patients. At the last follow up four patients had pain with vigorous activity (13%). Limitation of motion was severe in one patient (3%) and mild in two patients (6%). Average radial shortening was 4 millimeters and average volar tilt and unlar inclination were 5.4±6.6° and 12.5±4.5° respectively. Conclusion: Considering our clinical and radiological results it seems that external fixator is a good method for treatment of displaced intraarticular distal radial fractures.

Background: Fractures of distal radius are common, and complications related to the fracture pattern and treatment method are seen frequently. The efficiency of use of external fixators for unstable distal radius fractures treated at one of the University hospitals during a one year period is reported here. Material and method: 22 patients with unstable distal radius fracture were managed with closed reduction and external fixation with A.O. fixator. Clinical and radiographic evaluation after a mean period of 7.5 months ( 4.5-12 months) was performed. Functional evaluation by two scoring systems was done. The wrists "Grip strengths" were measured and compared with the opposite side. Results: On the basis of pain and range of motion, 12 cases had excellent, 6 good and 4 fair results. The radiographs were rated as excellent in 16, good in 5, and poor in 1 case. The length of radius was well maintained in 17 and had more than 1 millimeter shortening in 5 cases. The following complications were encountered: Pin tract infection in 2, loss of reduction in 1, dorsal first web space hypoesthesia in 1, finger stiffness in 2, Sudek's dystrophy in 3 cases. Conclusion: Although a small series, but a relatively low complication rate and good functional results make us advocate this treatment modality for the unstable distal radius fractures.

Background: Distal radius fractures are among the most common fractures. They can happen at any age group, and there are several treatment options and several classification systems for these fractures. One of these classifications is that of Fernandez. In this study, we evaluated the results of treatment of distal radius fractures by bridging external fixator and percutaneous pinning. Methods: In a cross-sectional study, 72 patients with Fernandez type 3, 4 and 5 that underwent external fixation and percutaneous pinning for comminuted distal radius fractures were followed and assessed after 3 and 6 months. Results: The 72 patients had mean age of 44. 2 years. 55% were male. The most common cause of fractures was vehicle accidents. 4 cases of malunion, 4 radial nerve injuries, 2 fixator loosening and 6 cases of infection were encountered. Conclusion: External fixator supplemented by percutaneous pinning is an efficient technique for treatment of unstable distal radius fractures. It has low rate of complication and high rate of patient's satisfaction.

Background: Perilunate dislocation and fracture-dislocation are rare injuries. Treatment of these injuries can be more challenging in old and neglected cases. In this study we report the outcomes of a two-stage treatment of old and neglected cases of these injuries by applying a distracting external fixator (first stage) and open reduction 3-4 weeks later (second stage). Methods: In this retrospective study, seven patients who underwent the two-stage treatment were included. Outcome measurements included Visual Analogue Scale (VAS) for pain, functional evaluation of the wrist by Disabilities of the Arm, Shoulder, and Hand (DASH), power and pinch grip assessment, radiocarpal range of motion and arthrosis in the radiocarpal and mid carpal joints. Results: Mean time interval between the injury and surgery was 7± 4. 9 months. Mean follow up period was 16. 8± 10. 7 months. Grip strength of the injured hand was 82. 1% of the contralateral hand. Pinch strength of the involved hand was 82. 5% of the contralateral hand. Range of motion in the radiocarpal joint of the injured hand was 49. 6% in flexion/extension and 64. 6% in ulnar/radial deviation of the uninjured hand, respectively. Mean VAS and DASH score were 4. 1 and 28. 5, respectively. Scaphoid nonunion was seen in one patient and radiocarpal joint arthrosis occurred in another one. Conclusion: According to the acceptable result of this study, we recommend twostage treatment for the management of old perilunate injuries.

An external skeletal fixator is an orthopedic method for treating open or closed fractures of long tubular bones, joint stiffness, bone lengthening, and congenital malformations. An external skeletal fixator is a device that is installed outside the organ and inserts pins into the fracture to fix it and adjust the position of the pin. They are connected to the frame and secured with bolts and nuts. Fixtures have changed significantly in appearance and biomechanics over time, but the principle and function remain the same. These fixtures consist of pins or thin stainless steel wires that penetrate the skin and reach the bone. This way the broken part is fixed in the right direction. Depending on the body geometry and shape, these external skeletal fixators are available in different types such as linear, circular, and hybrid fixators. The simplest and most common type of external skeletal fixator is the linear fixator. The use of an external fixator has several advantages over other fixation methods such as stabilization of the fracture at some distance from the injury site, no need for a cast, ease of patient movement, and minimal involvement of the joint. Premature loosening of the pin is the most common complication causing pain, inflammation, and discharge from the pin tract. Although these fixators are versatile and effective treatment models, they require careful maintenance during treatment. Before deciding to use an external fixator, the patient's and pet's owner's ability to comply with postoperative care instructions should be considered. This article reviews the types of external fixators, postoperative care, and their complications.