Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF

Abstract

The purpose of this study was to determine the most appropriate surgical treatment from three procedures used for fractures of the distal radius. In a retrospective comparative study, 166 out of 237 patients who underwent surgery for AO/ASIF A3 or C2 distal radius fractures were evaluated. Surgical procedures were external fixation or open reduction and internal fixation with either palmar or dorsal plates. Radiological outcomes were palmar tilt, radial angle, radial length and ulnar variance. Functional outcomes were range of motion and grip strength. In addition, outcomes according to Gartland and Werley and the Disabilities of the Arm, Shoulder and Hand questionnaire were compared. Further outcome criteria were the treatment time and the number of complications. Data were analysed using an analysis of variance statistical procedure respective of the chi2-test. Open reduction and internal fixation, in particular palmar plate fixation, demonstrated the best radiological and functional results. Subjective assessment of ORIF proved better than that of external fixation as treatment time was shorter and complications were more rarely seen. However, most of the differences between groups were not significant. Although there were no significant differences between groups, our data indicates that most dorsally displaced distal radius fractures can be treated successfully by open reduction and internal fixation. Palmar plate fixation seems to have slight advantages compared to both the external fixation and dorsal plate fixation surgical procedure.

Evaluation of a treatment protocol in distal radius fractures

“…Resuls are comparable to one other study using DASH comparing internal and external fixation (Westphal et al 2005). However, DASH was primarily intended for evaluation of the effect of some kind of intervention-such as a surgical procedure with a considerable impactand not to follow a cohort over time or to distinguish between 2 treatments.…”

Trends in the United States in the Treatment of Distal Radial Fractures in the Elderly

“…However, the rapid increase in the use of internal fixation corresponded with the earliest report on the volar locking plating system, which was published in 2000 19 . Before the introduction of the volar locking plating system, internal fixation was accomplished with a variety of methods, including dorsal plating, which today is viewed less favorably because of complications related to implant loosening, tendon rupture, and wrist stiffness [20][21][22][23][24] . These results are corroborated by an examination of American Board of Orthopaedic Surgery Part II oral examination data from 1999 to 2007.…”

Results after operation of unstable distal radius fractures in the elderly. A comparison of three treatments

“…In Tabelle Score nach Gartland and Werley zeigte in 85-100 % der Fälle gute und exzellente Ergebnisse [1,21,22].Auch der Martini-Score bestätigt dies (Abb. 5).…”

“…Allerdings wird bei diesem Verfahren auch beschrieben, daß aufgrund von postoperativen Stellungsverlusten, häufiger eine Reoperation im weiteren Verlauf notwendig wird [4,21]. Orbay (2002) berichtete, daß die palmare nichtwinkelstabile Plattenosteosynthese sogar bei dorsal dislozierten distalen Radiusfrakturen gute Ergebnisse zeigt.…”