Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-05-2013 | Orthopaedic Surgery

Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius

Authors: Georg Gradl, Gertraud Gradl, Martina Wendt, Thomas Mittlmeier, Guenther Kundt, Jesse B. Jupiter

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2013

Abstract

Background

The aim of this study was to compare non-bridging external fixation to palmar angular stable plating with respect to radiological outcome, wrist function, and quality of life.

Methods

One hundred and two consecutive patients (mean age: 63 years) were enrolled in the study. Fifty-two patients were randomized for plate osteosynthesis (2.4 mm, Synthes), 50 patients received non-bridging external fixation (AO small fixator). Objective (range of motion, grip strength), patient rated outcomes (quality of life, pain), and radiological outcome were assessed 8 weeks, 6 months, and 1 year after surgery.

Results

Loss of radial length of more than 3 mm was not detected in any group. Volar tilt was better restored by external fixation (7.2°) than by volar plating (0.1°). Wrist function was good in both groups. The external fixator was tolerated very well, and the quality of life assessment revealed comparable results in both groups. Osteoporosis was found in 54 % of patients and had no influence on radiological and functional outcome.

Conclusion

Non-bridging external fixation employing multiplanar K-wires is a suitable treatment option in intra- and extra-articular fractures of the distal radius even in osteoporotic bone.

Level of evidence

Prospective randomized trial, Level I.

Koval KJ, Harrast JJ, Anglen JO, Weinstein JN (2008) Fractures of the distal part of the radius. The evolution of practice over time. Where’s the evidence? J Bone Jt Surg Am 90(9):1855–1861. doi:10.2106/JBJS.G.01569 CrossRef

Ilyas AM, Jupiter JB (2010) Distal radius fractures–classification of treatment and indications for surgery. Hand Clin 26(1):37–42. doi:10.1016/j.hcl.2009.08.003 PubMedCrossRef

Maravic M, Le Bihan C, Landais P, Fardellone P (2005) Incidence and cost of osteoporotic fractures in France during 2001. A methodological approach by the national hospital database. Osteoporos Int 16(12):1475–1480. doi:10.1007/s00198-005-2031-0 PubMedCrossRef

Grewal R, Perey B, Wilmink M, Stothers K (2005) A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation. J Hand Surg Am 30(4):764–772. doi:10.1016/j.jhsa.2005.04.019 PubMedCrossRef

Leung F, Tu YK, Chew WY, Chow SP (2008) Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study. J Bone Jt Surg Am 90(1):16–22. doi:10.2106/JBJS.F.01581 CrossRef

Ring D, Jupiter JB (2005) Treatment of osteoporotic distal radius fractures. Osteoporos Int 16(Suppl 2):S80–S84. doi:10.1007/s00198-004-1808-x PubMedCrossRef

Bednar DA, Al-Harran H (2004) Non-bridging external fixation for fractures of the distal radius. Can J Surg 47(6):426–430PubMed

Gradl G, Jupiter JB, Gierer P, Mittlmeier T (2005) Fractures of the distal radius treated with a non-bridging external fixation technique using multiplanar K-wires. J Hand Surg Am 30(5):960–968. doi:10.1016/j.jhsa.2005.04.014 PubMedCrossRef

Windolf M, Schwieger K, Ockert B, Jupiter JB, Gradl G (2010) A novel non-bridging external fixator construct versus volar angular stable plating for the fixation of intra-articular fractures of the distal radius—a biomechanical study. Injury 41(2):204–209. doi:10.1016/j.injury.2009.09.025 PubMedCrossRef

10.

Muller ME, Nazarian S, Koch P (1990) The comprehensive classification of fractures of long bones. Springer-Verlag, Berlin

11.

Rosenberger WF, Lachin JM (2002) Randomization in Clinical Trials. Wiley, New York

12.

Protopsaltis TS, Ruch DS (2008) Volar approach to distal radius fractures. J Hand Surg Am 33(6):958–965. doi:10.1016/j.jhsa.2008.04.018 PubMedCrossRef

13.

Bullinger M, Morfeld M, Kohlmann T, Nantke J, van den Bussche H, Dodt B, Dunkelberg S, Kirchberger I, Kruger-Bodecker A, Lachmann A, Lang K, Mathis C, Mittag O, Peters A, Raspe HH, Schulz H (2003) SF-36 Health Survey in Rehabilitation Research. Findings from the North German Network for Rehabilitation Research, NVRF, within the rehabilitation research funding program. Rehabilitation (Stuttg) 42(4):218–225. doi:10.1055/s-2003-41645 CrossRef

14.

Medoff RJ (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin 21(3):279–288. doi:10.1016/j.hcl.2005.02.008 PubMedCrossRef

15.

Gartland JJ Jr, Werley CW (1951) Evaluation of healed Colles’ fractures. J Bone Jt Surg Am 33-A(4):895–907

16.

Castaing J (1964) Recent Fractures of the Lower Extremity of the Radius in Adults. Rev Chir Orthop Reparatrice Appar Mot 50:581–696PubMed

17.

Felsenberg D, Gowin W (1999) Bone densitometry by dual energy methods. Radiologe 39(3):186–193PubMedCrossRef

18.

Hove LM, Krukhaug Y, Revheim K, Helland P, Finsen V (2010) Dynamic compared with static external fixation of unstable fractures of the distal part of the radius: a prospective, randomized multicenter study. J Bone Jt Surg Am 92(8):1687–1696. doi:10.2106/JBJS.H.01236 CrossRef

19.

Hayes AJ, Duffy PJ, McQueen MM (2008) Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: a retrospective study of 588 patients. Acta Orthop 79(4):540–547. doi:10.1080/17453670710015553 PubMedCrossRef

20.

Fernandez DL (2000) Should anatomic reduction be pursued in distal radial fractures? J Hand Surg Br 25(6):523–527. doi:10.1054/jhsb.2000.0516 PubMedCrossRef

21.

Gausepohl T, Worner S, Pennig D, Koebke J (2001) Extraarticular external fixation in distal radius fractures pinplacement in osteoporotic bone. Injury 32(Suppl 4):SD79–85. doi:10.1016/S0020-1383(01)00117-6 PubMed

22.

McQueen MM (2005) Non-spanning external fixation of the distal radius. Hand Clin 21(3):375–380. doi:10.1016/j.hcl.2005.04.006 PubMedCrossRef

23.

Fischer T, Koch P, Saager C, Kohut GN (1999) The radio-radial external fixator in the treatment of fractures of the distal radius. J Hand Surg Br 24(5):604–609. doi:10.1054/jhsb.1999.0256 PubMedCrossRef

24.

Atroshi I, Brogren E, Larsson GU, Kloow J, Hofer M, Berggren AM (2006) Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: a randomized assessor-blind clinical trial of 38 patients followed for 1 year. Acta Orthop 77(3):445–453. doi:10.1080/17453670610046389 PubMedCrossRef

25.

Kapoor H, Agarwal A, Dhaon BK (2000) Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury 31(2):75–79PubMedCrossRef

26.

Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M (2009) A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma 23(4):237–242. doi:10.1097/BOT.0b013e31819b24e9 PubMedCrossRef

27.

Kuner EH, Mellios K, Berwarth H (2002) Treatment of complicated fracture of the distal radius with external fixator. Follow-up–complications–outcomes. Unfallchirurg 105(3):199–207PubMedCrossRef

28.

Gruber G, Zacherl M, Giessauf C, Glehr M, Fuerst F, Liebmann W, Gruber K, Bernhardt GA (2010) Quality of life after volar plate fixation of articular fractures of the distal part of the radius. J Bone Jt Surg Am 92(5):1170–1178. doi:10.2106/JBJS.I.00737 CrossRef

29.

Herron M, Faraj A, Craigen MA (2003) Dorsal plating for displaced intra-articular fractures of the distal radius. Injury 34(7):497–502. doi:10.1016/j.jhsa.2005.10.016 PubMedCrossRef

30.

McKay SD, MacDermid JC, Roth JH, Richards RS (2001) Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am 26(5):916–922. doi:10.1053/jhsu.2001.26662 PubMedCrossRef

31.

Al-Rashid M, Theivendran K, Craigen MA (2006) Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Jt Surg Br 88(12):1610–1612. doi:10.1302/0301-620X.88B12.17696 CrossRef

32.

Mackenney PJ, McQueen MM, Elton R (2006) Prediction of instability in distal radial fractures. J Bone Jt Surg Am 88(9):1944–1951. doi:10.2106/JBJS.D.02520 CrossRef

33.

Flinkkila T, Ristiniemi J, Hyvonen P, Hamalainen M (2003) Non-bridging external fixation in the treatment of unstable fractures of the distal forearm. Arch Orthop Trauma Surg 123(7):349–352. doi:10.1007/s00402-003-0539-3 PubMedCrossRef

34.

Egol KA, Paksima N, Puopolo S, Klugman J, Hiebert R, Koval KJ (2006) Treatment of external fixation pins about the wrist: a prospective, randomized trial. J Bone Jt Surg Am 88(2):349–354. doi:10.2106/JBJS.E.00011 CrossRef

35.

Drobetz H, Weninger P, Grant C, Heal C, Muller R, Schuetz M, Pham M, Steck R (2012) More is not necessarily better. A biomechanical study on distal screw numbers in volar locking distal radius plates. Injury. doi:10.1016/j.injury.2012.10.012 PubMed

Title: Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius
Authors: Georg Gradl
Gertraud Gradl
Martina Wendt
Thomas Mittlmeier
Guenther Kundt
Jesse B. Jupiter
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 5/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-013-1698-5

ACC 2024 Congress

Springer Medicine

Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius

Abstract

Background

Methods

Results

Conclusion

Level of evidence

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 5/2013

Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients

Radio-lunate arthrodesis in rheumatoid arthritis: outcome and techniques

The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture

Treatment of thumb soft-tissue defects using a bipedicle island flap of the index finger: anatomical basis and clinical application

Return to work and sports after total hip replacement

Orthopedic surgeon perspectives on appropriate referral of trauma patients to physical therapy (PT)