PREDICTION FOR NEED OF RE-MANIPULATION OF DISTAL RADIUS FRACTURES.

Distal radius fractures are commonest injury managed by junior doctors in accident and emergency department. Technique of manipulation is very well described and doctors are prepared from the days of medical school. Though manipulation is done in good position at initial management many patients require re-manipulation and surgical stabilisation due to loss of position on subsequent examination. Many Senior surgeon thinks this is due to inadequate plastering and moulding technique. Material and methods: We retrospectively, randomly selected 50 patients from 210 manipulations done in one year at District General Hospital. All these patients x-rays were reviewed and data collected for classification of fracture (Frykmann’s classification), radial height, ulnar varience, radial angulation, and Radial inclination measurements. Three Senior Orthopaedic Surgeons reviewed pre and post manipulation x-rays and asked for acceptability of initial reduction, plaster position and moulding signs on x-rays and asked to predict those requiring re-manipulation or loss of position. Results: 70% of the fractures were frykmann I or II as intra articular fractures Prediction of senior surgeon was right for more than 60 percent of the cases. Average radial angulation was 14 degree on post manipulation films. Radial height and inclination was average 6 mm and 18 degrees respectively. Discussion: Post manipulation is very important factor for maintaining reduction and poor moulding can lead to loss of position and require unnecessary additional operative procedure for initially well reduced fracture. Teaching of Plastering and moulding technique is very important skill development for junior doctors to improve outcome of these simple injuries