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.
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References
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
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
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
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
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
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
Bednar DA, Al-Harran H (2004) Non-bridging external fixation for fractures of the distal radius. Can J Surg 47(6):426–430
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
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
Muller ME, Nazarian S, Koch P (1990) The comprehensive classification of fractures of long bones. Springer-Verlag, Berlin
Rosenberger WF, Lachin JM (2002) Randomization in Clinical Trials. Wiley, New York
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
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
Medoff RJ (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin 21(3):279–288. doi:10.1016/j.hcl.2005.02.008
Gartland JJ Jr, Werley CW (1951) Evaluation of healed Colles’ fractures. J Bone Jt Surg Am 33-A(4):895–907
Castaing J (1964) Recent Fractures of the Lower Extremity of the Radius in Adults. Rev Chir Orthop Reparatrice Appar Mot 50:581–696
Felsenberg D, Gowin W (1999) Bone densitometry by dual energy methods. Radiologe 39(3):186–193
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
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
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
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
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
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
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
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):75–79
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
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):199–207
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
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
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
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
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
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
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
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
Acknowledgments
The study was supported by a grant from the AO.
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The authors declare that they have no conflict of interest.
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G. Gradl and G. Gradl contributed equally.
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Gradl, G., Gradl, G., Wendt, M. et al. 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, 595–602 (2013). https://doi.org/10.1007/s00402-013-1698-5
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DOI: https://doi.org/10.1007/s00402-013-1698-5