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Published in: Journal of Orthopaedics and Traumatology 4/2014

Open Access 01-12-2014 | Original Article

External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes

Authors: Rajeev Shukla, Ravi Kant Jain, Neeraj K. Sharma, Ravindra Kumar

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2014

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Abstract

Background

The objective of the study was to compare the efficacy of external fixation and volar plating on the functional parameter of displaced intra-articular (Cooney’s type IV) distal end radius fractures using the Green and O’Brien scoring system.

Materials and methods

This prospective randomized study comprised 68 patients treated with external fixation and 42 patients treated with volar locking plates. The patients were followed up at 6 months and 1 year after surgery. The assessment of pain, range of motion, grip strength and activity were assessed at each follow-up visit and scored according to the Green and O’Brien scoring system.

Results

At 1 year after surgery, we observed that external fixation showed significantly better results than volar locking plates using the Green and O’Brien scores for range of motion (22.0 ± 4.77 vs 19.89 ± 5.05), grip strength (19.91 ± 5.4 vs 16.89 ± 4.4) and final outcome (87.36 ± 11.62 vs 81.55 ± 11.32). No difference was found in pain and activity between these two groups of patients. Patients aged <50 years treated with external fixation showed excellent results (final score (91.57 ± 9.01) at 1 year follow-up.

Conclusion

External fixation showed superiority over volar locked plating after 1 year of surgery.

Level of evidence

IV.
Literature
1.
go back to reference Jupiter JB (1991) Fractures of the distal end of the radius. J Bone Jt Surg Am 73:461–469 Jupiter JB (1991) Fractures of the distal end of the radius. J Bone Jt Surg Am 73:461–469
2.
go back to reference Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring D (2010) Distal radius work group: the treatment of distal radius fractures. J Am Acad Orthop Surg 18:180–189PubMed Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring D (2010) Distal radius work group: the treatment of distal radius fractures. J Am Acad Orthop Surg 18:180–189PubMed
3.
go back to reference Handoll HH, Huntley JS, Madhok R (2007) External fixation versus conservative treatment for distal radial fractures in adults. Cochrane Database Syst Rev 18(3):CD006194 Handoll HH, Huntley JS, Madhok R (2007) External fixation versus conservative treatment for distal radial fractures in adults. Cochrane Database Syst Rev 18(3):CD006194
4.
go back to reference Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg Am 68:647–659 Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg Am 68:647–659
5.
go back to reference Jupiter JB, Ring D, Weitzel PP (2002) Surgical treatment of re-displaced fractures of the distal radius in patients older than 60 years. J Hand Surg Am 27:714–723PubMedCrossRef Jupiter JB, Ring D, Weitzel PP (2002) Surgical treatment of re-displaced fractures of the distal radius in patients older than 60 years. J Hand Surg Am 27:714–723PubMedCrossRef
6.
7.
go back to reference Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM (2006) Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Jt Surg Am 88:2687–2694CrossRef Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM (2006) Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Jt Surg Am 88:2687–2694CrossRef
8.
go back to reference Schnall SB, Kim BJ, Abramo A, Kopylov P (2006) Fixation of distal radius fractures using a fragment-specific system. Clin Orthop 445:51–57PubMed Schnall SB, Kim BJ, Abramo A, Kopylov P (2006) Fixation of distal radius fractures using a fragment-specific system. Clin Orthop 445:51–57PubMed
9.
go back to reference Konstantinos CX, Dionysios AV, Konstantinos JK (2009) Classifying fractures of the distal radius: impossible or unnecessary? Review of the literature and proposal of a grouping system. Med Sci Monit 15(3):RA67–RA74 Konstantinos CX, Dionysios AV, Konstantinos JK (2009) Classifying fractures of the distal radius: impossible or unnecessary? Review of the literature and proposal of a grouping system. Med Sci Monit 15(3):RA67–RA74
10.
go back to reference 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 31:75–79PubMedCrossRef 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 31:75–79PubMedCrossRef
11.
go back to reference Wright TW, Horodyski M, Smith DW (2005) Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am 30:289–299PubMedCrossRef Wright TW, Horodyski M, Smith DW (2005) Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am 30:289–299PubMedCrossRef
12.
go back to reference Egol K, Walsh M, Tejwani N, McLaurin T, Wynn C, Paksima N (2008) Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for the unstable fractures of the distal radius: a randomised, prospective trial. J Bone Jt Surg 90-A:1214–1221CrossRef Egol K, Walsh M, Tejwani N, McLaurin T, Wynn C, Paksima N (2008) Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for the unstable fractures of the distal radius: a randomised, prospective trial. J Bone Jt Surg 90-A:1214–1221CrossRef
13.
go back to reference Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP (2009) Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. J Bone Jt Surg 91-A:1568–1577CrossRef Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP (2009) Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. J Bone Jt Surg 91-A:1568–1577CrossRef
14.
go back to reference Gereli A, Nalbantoğlu U, Kocaoğlu B, Türkmen M (2010) Comparison of palmar locking plate and K-wire augmented external fixation for intra-articular and comminuted distal radius fractures. Acta Orthop Traumatol Turc. 44(3):212–219PubMedCrossRef Gereli A, Nalbantoğlu U, Kocaoğlu B, Türkmen M (2010) Comparison of palmar locking plate and K-wire augmented external fixation for intra-articular and comminuted distal radius fractures. Acta Orthop Traumatol Turc. 44(3):212–219PubMedCrossRef
15.
go back to reference Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC (2005) A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg Am 30:1185–1199PubMedCrossRef Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC (2005) A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg Am 30:1185–1199PubMedCrossRef
16.
go back to reference Walenkamp MM, Bentohami A, Beerekamp MS, Peters RW, van der Heiden R, Goslings JC, Schep NW (2013) Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strategies Trauma Limb Reconstr 8(2):67–75PubMedCentralPubMedCrossRef Walenkamp MM, Bentohami A, Beerekamp MS, Peters RW, van der Heiden R, Goslings JC, Schep NW (2013) Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strategies Trauma Limb Reconstr 8(2):67–75PubMedCentralPubMedCrossRef
17.
go back to reference Gradl G, Gradl G, Wendt M, Mittlmeier T, Kundt G, Jupiter JB (2013) Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius. Arch Orthop Trauma Surg 133(5):595–602PubMedCrossRef Gradl G, Gradl G, Wendt M, Mittlmeier T, Kundt G, Jupiter JB (2013) Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius. Arch Orthop Trauma Surg 133(5):595–602PubMedCrossRef
18.
go back to reference Westphal T, Piatek S, Schubert S, Winckler S (2005) Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF. Arch Orthop Trauma Surg 125:507–514PubMedCrossRef Westphal T, Piatek S, Schubert S, Winckler S (2005) Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF. Arch Orthop Trauma Surg 125:507–514PubMedCrossRef
19.
go back to reference Wolfe SW (2009) Patterns and treatment of distal radius fractures. In: Proceedings of the AAOS/ASSH update on the painful and injured wrist. May 29–30, Rosemont, IL, p 66 Wolfe SW (2009) Patterns and treatment of distal radius fractures. In: Proceedings of the AAOS/ASSH update on the painful and injured wrist. May 29–30, Rosemont, IL, p 66
20.
go back to reference Grewal R, MacDermid JC, King JC, Faber KJ (2011) Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg 36:1899–1906CrossRef Grewal R, MacDermid JC, King JC, Faber KJ (2011) Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg 36:1899–1906CrossRef
21.
go back to reference Kamano M, Honda Y, Kazuki K, Yasuda M (2002) Palmar plating for dorsally displaced fractures of the distal radius. Clin Orthop Relat Res 397:403–408PubMedCrossRef Kamano M, Honda Y, Kazuki K, Yasuda M (2002) Palmar plating for dorsally displaced fractures of the distal radius. Clin Orthop Relat Res 397:403–408PubMedCrossRef
22.
go back to reference Landgren M, Jerrhag D, Tägil M, Kopylov P, Geijer M, Abramo A (2011) External or internal fixation in the treatment of non-reducible distal radial fractures? A 5-year follow-up of a randomized study involving 50 patients. Acta Orthop 82:610–613PubMedCentralPubMedCrossRef Landgren M, Jerrhag D, Tägil M, Kopylov P, Geijer M, Abramo A (2011) External or internal fixation in the treatment of non-reducible distal radial fractures? A 5-year follow-up of a randomized study involving 50 patients. Acta Orthop 82:610–613PubMedCentralPubMedCrossRef
23.
go back to reference Wilcke MK, Abbaszadegan H, Adolphson PY (2011) Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year. Acta Orthop 82:76–81PubMedCentralPubMedCrossRef Wilcke MK, Abbaszadegan H, Adolphson PY (2011) Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year. Acta Orthop 82:76–81PubMedCentralPubMedCrossRef
24.
go back to reference Kumbaraci M, Kucuk L, Karapinar L, Kurt C, Coskunol E (2013) Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures. Eur J Orthop Surg Traumatol 24(2):173–178PubMedCrossRef Kumbaraci M, Kucuk L, Karapinar L, Kurt C, Coskunol E (2013) Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures. Eur J Orthop Surg Traumatol 24(2):173–178PubMedCrossRef
25.
go back to reference Marcheix PS, Dotzis A, Benkö PE, Siegler J, Arnaud JP, Charissoux JL (2010) Extension fractures of the distal radius in patients older than 50: a prospective and randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg (Eur) 35(8):646–651CrossRef Marcheix PS, Dotzis A, Benkö PE, Siegler J, Arnaud JP, Charissoux JL (2010) Extension fractures of the distal radius in patients older than 50: a prospective and randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg (Eur) 35(8):646–651CrossRef
Metadata
Title
External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes
Authors
Rajeev Shukla
Ravi Kant Jain
Neeraj K. Sharma
Ravindra Kumar
Publication date
01-12-2014
Publisher
Springer International Publishing
Published in
Journal of Orthopaedics and Traumatology / Issue 4/2014
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI
https://doi.org/10.1007/s10195-014-0317-8

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