Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation versus Bridging External Fixation

Fakoor, Mahdi; Mohammadhoseini, Payam

doi:10.5812/traumamon.17631v2

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…Seven articles 7 , 8 , 9 , 10 , 11 , 12 , 13 were eventually included. The characteristics of the included studies were summarized in Table 1 and the search process was shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Locking plate versus external fixation for type C distal radius fractures: A meta-analysis of randomized controlled trials

Wang

Shan

Zhou

2018

Chinese Journal of Traumatology

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PurposeDistal radial fracture is one of the most common fractures. Up to now, locking plates (LP) and external fixation (EF) are two conventional surgical approaches to type C radius fracture. Which method is superior has not yet reached a consensus. We try to assess the clinical effectiveness of the two interventions by this meta-analysis.MethodsWe used network to search the PubMed, Embase, and Cochrane Medical Library of randomized controlled clinical trials about the type C distal radius fractures performed according to the search strategy mentioned in Cochrane Handbook 5.1.0 from Jan. 2005 to Jan. 2016. Patients in the experimental group were used LP, in the control group were included EF and other surgical approaches. Publication language was restricted to English. Studies that patient population and surgical indication did not define had been excluded. Studies must report at least one of the outcomes as follow: radial inclination, palmar tilt, ulnar variance, range of wrist flexion and extension, and range of wrist supination and pronation. The trials in which participants included children were excluded. We used Jadad study scores to appraise the study.ResultsSeven studies included 162 patients (LP group) and 190 patients (EF group). We compared the radial inclination, palmar tilt, ulnar variance, range of wrist flexion and extension, and range of wrist supination and pronation. The radial inclination were revealed a difference favoring LP over EF [WMD = 1.84, 95% CI (0.17, 3.50), p = 0.03] and the palmar tilt and ulnar variance was no significant difference between the two groups [(WMD = 3.61, 95% CI (0.00, 7.23), p = 0.05; WMD = 0.05, 95% CI (−0.99, 1.09), p = 0.93]. The functional activities of range of flexion and extension and range of supination and pronation between the two groups was no difference [WMD = 10.04, 95% CI (−6.88, 26.96), p = 0.24; WMD = 12.53, 95% CI (−9.99, 35.06), p = 0.28].ConclusionLocking plate and external fixation is feasible to heal radius type C fracture. We found the small difference between the two groups on imaging examination. The locking plate has the advantage on maintaining reduction, however no significant difference regarding outcomes has been found between the two groups.

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“…Seven articles 7 , 8 , 9 , 10 , 11 , 12 , 13 were eventually included. The characteristics of the included studies were summarized in Table 1 and the search process was shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Locking plate versus external fixation for type C distal radius fractures: A meta-analysis of randomized controlled trials

Wang

Shan

Zhou

2018

Chinese Journal of Traumatology

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“…1). Seven articles compared volar plating with dorsal plating [1,8,24,29,30,34,53], eight compared volar plating with casting [2,5,10,18,29,43,44,54], 15 compared volar plating with external fixation [3,7,11,12,15,17,21,23,36,39,40,42,50,52,55], and six compared volar plating with K-wire fixation [9,27,32,35,51,56]. Study characteristics, including the number of patients in each treatment group, the sensitivity analyses implemented (if any), and RRs for total and major complications were recorded (Table 1).…”

Section: Study Retrieval and Characteristicsmentioning

confidence: 99%

Are Observational Studies on Distal Radius Fracture Treatment Robust? An E-value Approach to Analysis

Wang

Chung

Baxter

et al. 2023

Clin Orthop Relat Res

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BackgroundReported complication frequencies after distal radius fracture (DRF) treatment vary widely in the literature and are based mostly on observational evidence. Whether that evidence is sufficiently robust to use in practice is controversial. The E-value is an innovative sensitivity analysis that quantitates the robustness of observational evidence against unmeasured confounders, whereby a greater E-value usually implies more robust evidence and vice versa; with DRF complications, this approach can help guide readers to a more confident interpretation of the available evidence.Questions/purposesIn this study, we sought (1) to compare the complication frequencies among different DRF treatment modalities, and (2) to evaluate the robustness of these observational studies using the E-value as an index for unmeasured confounding.MethodsWe searched PubMed, Embase, and SCOPUS for observational studies on the management of DRFs that were published from January 2001 to July 2021 with the last database search performed on July 31, 2021. All articles that compared different DRF treatment modalities with reported complication frequencies were included to accurately capture the quality of the observational studies in research about DRF. Risk ratios (RRs) of the overall complication and major complication risks were calculated for each subgroup comparison: volar plating versus dorsal plating, casting, external fixation, and percutaneous K-wire fixation. The RRs and their corresponding lower limits of the 95% confidence intervals (CIs) were used to derive the E-values. E-values can have a minimum possible value of 1, which signifies that the treatment-outcome association is not strong and can readily be overturned by unmeasured confounders. By contrast, a large E-value means that the observed treatment-outcome association is robust against unmeasured confounders. We averaged RRs and E-values for the effect estimates and lower limits of CIs across studies in each treatment comparison group. We identified 36 comparative observational studies that met the inclusion criteria. Seven studies compared volar with dorsal plating techniques. Volar plating was also compared with casting (eight studies), external fixation (15 studies), and percutaneous K-wire fixation (six studies).ResultsTotal and major complication risks did not differ among different DRF treatments. The mean RRs for total and major complications were 1.2 (95% CI 0.4 to 3.9; p = 0.74) and 1.8 (95% CI 0.4 to 11.4; p = 0.52) for the volar versus dorsal plating group; 1.2 (95% CI 0.3 to 11.2; p = 0.87) and 1.5 (95% CI 0.3 to 14.9; p = 0.74) for the volar plating versus casting group; 0.6 (95% CI 0.2 to 2.2; p = 0.33) and 0.8 (95% CI 0.2 to 6.7; p = 0.86) for the volar plating versus external fixation group; and 0.6 (95% CI 0.2 to 2.6; p = 0.47) and 0.7 (95% CI 0.2 to 4.0; p = 0.67) for the volar plating versus K-wire fixation group. The mean E-values for total and major complication frequencies for the between-group comparison ranged from 3.1 to 5.8; these were...

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“… 5 Furthermore, although traditional joint-bridging external fixation can maintain the radial length with minimal injury and allow limited postoperative adjustments, excessive distraction can lead to persistent motion restriction of the wrist and severe reflex sympathetic dystrophy. 6 …”

Section: Introductionmentioning

confidence: 99%

“…5 Furthermore, although traditional jointbridging external fixation can maintain the radial length with minimal injury and allow limited postoperative adjustments, excessive distraction can lead to persistent motion restriction of the wrist and severe reflex sympathetic dystrophy. 6 Nonbridging external fixation for DRFs combines closed reduction and early immobilization, and this technique has been recommended for DRFs with broad and rigid fracture fragments to accommodate several fixator pins, which is limited in osteoporotic fractures. 7 We have used a hybrid nonbridging external fixation (NBEF) technique (Zimmer-Centerpulse AG, Zurich, Switzerland) supplemented by K-wires in the treatment of unstable osteoporotic extra-articular and simple intra-articular DRFs in patients of advanced age (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Early hybrid nonbridging external fixation of unstable distal radius fractures in patients aged ≥50 years

Peng

Chen

et al. 2019

J Int Med Res

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Objective We evaluated hybrid nonbridging external fixation (NBEF) supplemented by K-wires as an effective and safe treatment option for osteoporotic distal radius fractures (DRFs) in a retrospective case series. Methods Sixteen extra-articular and one intra-articular DRF were treated by NBEF from 2016 to 2018 (mean patient age, 61.8 years; 15 women, 1 man). Radiographic parameters (volar tilt, radial inclination, and ulnar variance), range of motion, grip power, the visual analog scale score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed at 4 weeks, 6 weeks, 6 months, and 12 months postoperatively. Results The volar tilt and radial inclination were restored after surgery and maintained well. The mean visual analog scale score was 4 ± 1 at 4 weeks. Range of motion was restored to 79% to 91% at 6 weeks. The DASH score was good before NBEF device removal. Two superficial pin-tract infections were easily treated with antibiotics. Conclusions Hybrid NBEF transfixes DRFs in a multiplanar fashion, and augmentation with percutaneous K-wires provides direct fixation in radial shift and withstands axial loads in fracture fragments. It allows early mobilization with rigid fixation. Hybrid NBEF is reliable for unstable extra-articular and simple intra-articular DRFs in older patients. Clinical Study registration number ChiCTR1900021712

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Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation versus Bridging External Fixation

Cited by 3 publications

References 16 publications

Locking plate versus external fixation for type C distal radius fractures: A meta-analysis of randomized controlled trials

Locking plate versus external fixation for type C distal radius fractures: A meta-analysis of randomized controlled trials

Are Observational Studies on Distal Radius Fracture Treatment Robust? An E-value Approach to Analysis

Early hybrid nonbridging external fixation of unstable distal radius fractures in patients aged ≥50 years

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