A comparative study of functional outcome of external fixation and volar plating in unstable distal radius fractures

Anil Kumar Mishra, Ajay Deep Sud, Manish Prasad, Rajiv Kaul, Chander Mohan Singh


Background: Distal radius fractures are amongst the most common injuries seen in the emergency department. It is imperative to restore the anatomy as much as possible in order to restore wrist function. Identifying a fracture as ‘unstable’ is critical in predicting the final outcome of treatment. The present study compares two primary modalities of treatment: external fixation and volar plating in terms of the functional outcome post-surgery.  Aim of the study was to compare the functional outcome of fixation of unstable distal radius fractures by external fixation to that of volar plating by the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system and analysis of recovery of grip strength and range of motion. Settings and design: Hospital-based; randomized control trial.

Methods: 80 patients presenting with unstable distal radius fractures were randomized into two groups of 40 each. One group received external fixation and the second received open reduction with volar plate fixation as the primary intervention. DASH scores were obtained and compared at specified time intervals following surgery.

Results: The results of our study show a better improvement in the mean DASH scores at 3, 6 and 12 months in the volar plating group as compared to the external fixation group.

Conclusions: Volar plating, with its definitive advantage of direct fracture visualization, has an overall better functional outcome with greater postoperative wrist motion and a lower incidence of complications. 


Unstable, Distal radius fractures, External fixation, Volar plating, Functional outcome, DASH score

Full Text:



Jupiter JB. Current concepts review: fractures of the distal end of the radius. J Bone Joint Surg Am. 1991;73(3):461-9.

Lafontaine M, Delince P, Hardy D, Simons M. Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta orthopaedica belgica. 1989;55(2):203-16.

Gartland J, Evaluation of healed Colles' fractures. J Bone Joint Surg Am. 1984;33:747-9.

Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am. 1994;19(2):325-40.

Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults: a descriptive arthroscopic study in 50 patients. J Hand Surg Am. 1997;22(5):638-43.

Baratz ME, Des Jardins JD, Anderson DD, Imbriglia JE. Displaced intra-articular fractures of the distal radius: The effect of fracture displacement on contract stresses in a cadaver model. J Hand Surg Am. 1996;21(2):183-8.

Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am. 2009;91(7):1568-77.

Kapoor H, Agarwal A, Dhaon B. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury. 2000;31(2):75-9.

Kreder H, Hanel D, Agel J, McKee M, Schemitsch E, Trumble T, et al. Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomised, controlled trial. J Bone Joint Surg Am. 2005;87(6):829-36.

Shukla R, Jain RK, Sharma NK, Kumar R. External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes. J Orthop Traumatol. 2014;15(4):265-70.

Egol K, Walsh M, Tejwani N, McLaurin T, Wynn C, Paksima N. Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. J Bone Joint Surg Am. 2008;90(9):1214-21.

Navarro CM, Ahrengart L, Törnqvist H, Ponzer S. Volar locking plate or external fixation with optional addition of K-wires for dorsally displaced distal radius fractures: a randomized controlled study. J Orthop Trauma. 2016;30(4):217-24.

Wilcke MK, Abbaszadegan H, Adolphson PY. Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year: A randomized study of 63 patients with a dorsally displaced fracture of the distal radius. Acta orthopaedica. 2011;82(1):76-81.

Walenkamp MM, Bentohami A, Beerekamp MSH, Peters RW, van der Heiden R, Goslings JC, et al. Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strategies in Trauma and Limb Reconstruction. Strategies Trauma Limb Reconstr. 2013;8(2):67-75.

Wei DH, Poolman RW, Bhandari M, Wolfe VM, Rosenwasser MP. External fixation versus internal fixation for unstable distal radius fractures: a systematic review and meta-analysis of comparative clinical trials. J Orthop Trauma. 2012;26(7):386-94.

Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PR. External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury. 2013;44(4):409-16.

Agee JM. Distal radius fractures. Multiplanar ligamentotaxis. Hand clinics. 1993;9(4):577-85.

Agee JM, Szabo RM, Chidgey LK, King FC, Kerfoot C. Treatment of comminuted distal radius fractures: an approach based on pathomechanics. Orthopedics. 1994;17(12):1115-22.

Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. JBJS. 2002;84(2):208-15.

Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC musculoskeletal disorders. 2003;4(1):11.

Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg. 1984;9(2):222-6.

MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH. Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. J Hand Surg. 2000;25(2):330-40.

Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther. 1989;43(7):444-7.

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. Clinic Rhinol. 2010;1(1):1-7.

Venkatesh Gupta SK, Mandapalli P. Comparative Study between Bridging External Fixation vs Volar Plating (Ellis-T Plate) for Comminuted Fracture of the Distal End Radius. 2015: 20-4.

Walenkamp MM, Bentohami A, Beerekamp MS, Peters RW, van der Heiden R, Goslings JC, et al. Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strategies Trauma Limb Reconstr. 2013;8(2):67-75.

Wang J, Yang Y, Ma J, Xing D, Zhu S, Ma B, et al. Open reduction and internal fixation versus external fixation for unstable distal radial fractures: a meta-analysis. Orthop Traumatol Surg Res. 2013;99(3):321-31.

Li-hai Z, Ya-nan W, Zhi M, Li-cheng Z, Hong-da L, Huan Y, et al. Volar locking plate versus external fixation for the treatment of unstable distal radial fractures: a meta-analysis of randomized controlled trials. J Surg Res. 2015;193(1):324-33.