External fixation versus plating in intra-articular distal end radius fractures
Keywords:Volar locking plate, External fixation, Distal end radius fracture, Intra-articular
Background: Distal end radius fractures are one of the most common encountered fractures in Orthopaedics. Prompt intervention in terms of volar locking plate or external fixation can be performed. The purpose of this study was to derive a better outcome as to which type of fixation is a better choice for the treatment of intra-articular distal end radius fracture.
Methods: A prospective randomized controlled study was conducted with 30 patients and comparison was made between the plating and external fixator group using the modified clinical-scoring system of Green and O'Brien and demerit point system at each follow-up.
Results: In the plating group 14 patient’s fracture united in 6th week and 1 patient’s fracture united at 8th week this result was similar to the external fixator group were 14 patient’s fracture united in 6th week and 1 patient’s fracture united at 8th week. 1 patient each developed wrist joint stiffness and delayed union in the plating group as compared to the external fixator group were 1 patient each developed wrist joint stiffness, delayed union and broken implant in situ and pin tract infection.
Conclusions: During the initial follow ups the functional outcome of the plating group were better than the external fixator group but as the time passed at the final follow up plating was only marginally better than the external fixator group. It was seen that radiologically plating lead to a better correction of all the parameters as compared to external fixator group.
Bucholz RW, Heckman JD, Court Brown CM, Tornetta P. Rockwood and Green’s Fracture in Adults. 7th edition. Philadelphia: Lippincott Williams and Wilkins; 2010.
Chung KC, Spilson SV. The Frequency and Epidemiology of Hand and Forearm Fractures in the United States. J Hand Surg (Am). 2001;26:908-15.
Nijs S, O’Broos PL. Fractures of the Distal Radius:A Contemporary Approach. Acta Chir Belg. 2004;104:401-12.
Knirk JL, Jupiter JB. Intra-articular Fractures of the Distal End of Radius in Young Adults. JBJS(Am). 1986;68(5):647-59.
Mehta JA, Bain GI, Heptinstall RJ. Anatomical Reduction of Intra-articular Fractures of the Distal Radius: An Arthroscopically-Assisted Approach. JBJS (Br). 2000;82-B:79-86.
Komurcu M, Kamaci L, Ozdemir MT, Atesalp AS, Basbozkurt M. Treatment of AO type C2-C3 Fractures of the Distal End of the Radius with External Fixation of Distal Radius. Acta Orthop Traumatol Turc. 2005;39(1):39-45.
Gruber G, Zacherl M, Giessauf C, Glehr M, Fuerst F, Liebmann W, et al. Quality of Life After Volar Plate Fixation of Articular Fractures of the Distal Part of the Radius. JBJS (Am). 2010;92:1170-8.
Leung F, Tu Y, Chew WYC, Chow S. Comparison of external and percutaneous pin fixation with plate fixation for intra-articulardistal radial fractures a randomized study. J Bone Joint Surg 2008;90:16-22.
Rogachefsky RA, Lipson SR, Anne E, Savenor AM, J Mcauliffe JA. Treatment of Severely Comminuted Intra-Articular Fractures of the Distal End of the Radius by Open Reduction and Combined Internal and External Fixation. JBJS(Am). 2001;83:509.
Arora J, Kapoor H, Malik A, Bansal M. Closed reduction and plaster cast immobilization vs. external fixation in comminuted intra-articular fractures of distal radius. Indian Journal of Orthopaedics 2004:38:113-117.
Wei X, Sun Z, Rui Y, Song X. Minimally invasive plate osteosynthesis for distal radiusfractures. Indian Journal of Orthopaedics. 2014;48(1):20-24.
Pradhan U, Agrawal A, Prasad P, Chauhan V, Maheshwari R, Juyal A. Clinico-radiological and functional outcome after surgical fixation of intra-articular fractures of distal end of radius by external fixator verses locked volar plate:a prospective randomised study. IOSR Journal of Dental and Medical Sciences. 2013;6(3):20-26.
Gereli A, Nalbantoğlu U, Kocaoğlu B, Türkmen M. Comparison of Palmar Locking Plate and K-wire Augmented External Fixation for Intra-articular and Comminuted Distal Radius Fractures. JBJS(Am). 2010;92:96-106.
Aro TH, Koivunen T. Minor axial shortening of the radius affects outcome of Colles’ fracture treatment. J Hand Surg. 1991;16A:392-8.
Fernandez LD, Geissler BW. Treatment of displaced articular fractures of the radius. 1991;16A:375-84.
Kapoor H, Agarwal A, Dhaon BK. Displaced intra articular fractures of distal radius :A comparative evaluation of results following closed reduction external fixators and ORIF Injury 2000 ;31(2) :75-79.
Richard MJ, Wartinbee DA, Miller M, Leversedge FJ, Riboh J, Ruch DS. Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius. The Duke Orthop J. 2011;1(1):1-7.
Kaempffe FA, Walker KM. External fixation for distal radius fractures:Effect of distraction on outcome. Clin Orthop Relat Res. 2000;380:220-5.
Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional Outcomes for Unstable Distal Radial Fractures Treated with Open Reduction and Internal Fixation or Closed Reduction and Percutaneous Fixation. JBJS (Am). 2009;91:1837-46.