International Orthopaedics

, Volume 35, Issue 9, pp 1333–1341

Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis

  • Zhuang Cui
  • Jianhong Pan
  • Bin Yu
  • Kairui Zhang
  • Xiaolong Xiong
Review

Abstract

Purpose

Our aim was to compare the effect of internal vs external fixation for unstable distal radius fractures regarding postoperative complications, clinical results and radiological outcomes.

Methods

We selected PubMed; Cochrane Library; EMBASE; BIOSIS; Ovid and the relevant English orthopaedic journals and pooled data from ten eligible randomised controlled trials containing 738 patients to conduct a subgroup analysis according to different periods of follow-up. Our aim was to summarise the best available evidence.

Results

Results showed that compared with external fixation, internal fixation led to significantly fewer total surgical complications [95% confidence interval (CI) 0.39–0.81, P = 0.002] and reduced the incidence of pin-track infections (95% CI 0.08–0.46, P = 0.0002) after a one year follow-up. For clinical results, grip strength (95% CI 1.59–8.25, P = 0.004), supination (95% CI 13.99–48.83, P = 0.0004) and pronation (95% CI 5.61–26.09, P = 0.002) were superior in the internal fixation group six weeks postoperatively, and the same results were obtained three months postoperatively for grip strength (95% CI 3.21–13.47, P = 0.001) and supination (95% CI 3.61–16.01, P = 0.002). Meanwhile, the Disabilities of the Arm, Shoulder and Hand (DASH) score was superior in the internal fixation group at three months (95% CI −20.62 to −2.07, P = 0.02) and after one year (95% CI −14.37 to −2.32, P = 0.007) follow-up.

Conclusions

We suggest that the final results are significant and there is some evidence supporting the use of open reduction and internal fixation.

References

  1. 1.
    Kotnis R, Waites TD, Fayomi O, Dega R (2005) The use of a template to improve the managemeng of distal radial fractures. Emerg Med J 22:544–547PubMedCrossRefGoogle Scholar
  2. 2.
    Xu GG, Chan SP, Puhaindran ME, Chew WY (2009) Prospective randomised study of intra-articular fractures of the distal radius: comparison between external fixation and plate fixation. Ann Acad Med Singapore 38:600–606PubMedGoogle Scholar
  3. 3.
    Abramo A, Kopylov P, Geijer M, Tagil M (2009) Open reduction and internal fixation compared to closed reduction and external fixation in distal radius fractures: A randomized study of 50 patients. Acta Orthop 80:478–485PubMedCrossRefGoogle Scholar
  4. 4.
    Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS (2009) Functional outcomes for unstable distal fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation: a prospective randomized trial. J Bone Joint Surg Am 91:1837–1846PubMedCrossRefGoogle Scholar
  5. 5.
    Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP (2009) Unstable distal radial fractrures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am 91:1568–1577PubMedCrossRefGoogle Scholar
  6. 6.
    Leung F, Tu Y, Chew WY, Chow SP (2008) Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radius fractures: a randomized study. J Bone Joint Am 90:16–22CrossRefGoogle Scholar
  7. 7.
    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 unstable fractures of the distal radius: a randomized, prospective trial. J Bone Joint Surg Br 90:1214–1221PubMedCrossRefGoogle Scholar
  8. 8.
    Kreder HJ, Hanel DP, Agel J et al (2005) Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius. J Bone Joint Surg Br 87:829–836PubMedCrossRefGoogle Scholar
  9. 9.
    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 30:764–772PubMedCrossRefGoogle Scholar
  10. 10.
    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 31:75–79PubMedCrossRefGoogle Scholar
  11. 11.
    McQueen MM, Hajducka C, Court-Brown CM (1996) Redisplaced unstable fractures of the distal radius: a prospective randomized comparison of four methods of treatment. J Bone Joint Surg Br 78:404–409PubMedGoogle Scholar
  12. 12.
    Kateros K, Macheras G, Galanakos SP, Sofianos I, Papakostas I, Papadkis SA (2010) External fixation versus “∏” plate for distal radius fractures. J Trauma 68:166–172PubMedCrossRefGoogle Scholar
  13. 13.
    Handoll HH, Madhok R (2009) WITHDRAWN: Surgical interventions for treating distal radial fractures in adults. Cochrane Datebase Syst Rev CD003209Google Scholar
  14. 14.
    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 30:1185–1199PubMedCrossRefGoogle Scholar
  15. 15.
    Paksima N, Panchal A, Posner MA, Green SM, Mehiman CT, Hiebert R (2004) A Meta-analysis of the literature on distal radius fractures: review of 615 articles. Bull Hosp Jt Dis 62:40–46PubMedGoogle Scholar
  16. 16.
    Higgins J, Green S (2006) Cochrane handbook for systematic reviews of interventions 4.2.6. In the Cochrane library Wiley: Chichester 301. (Updated September 2006)Google Scholar
  17. 17.
    Moher D, Cook DJ, Eastwood S, OIkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of Meta-analyses of randomized controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 354:1896–1900PubMedCrossRefGoogle Scholar
  18. 18.
    Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 18:151–154Google Scholar
  19. 19.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analysis. BMJ 327:557–560PubMedCrossRefGoogle Scholar
  20. 20.
    Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y (2001) Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 12:232–236PubMedCrossRefGoogle Scholar
  21. 21.
    Breierova L, Choudhari M (1996) An introduction to sensitivity analysis. MIT Pr 41–107Google Scholar
  22. 22.
    Egger M, Davey SG, Altman DG (2001) Systematic reviews in health care: Meta-analysis in context. BMJ books, LondonCrossRefGoogle Scholar
  23. 23.
    Greenhalgh T (2001) How to read a paper. BMJ Books, The basics of evidence based medicine. LondonGoogle Scholar
  24. 24.
    O’Neill TW, Cooper C, Finn JD et al (2001) Incidence of distal forearm fracture in British men and women. Osteoporosis International 12:555–558PubMedCrossRefGoogle Scholar
  25. 25.
    Sakhaii M, Groenewold U, Klonz A, Reilmann H (2003) Results after palmar plate-osteosynthesis with angularly stable T-plate in 100 distal radius fractures: a prospective study. Unfallchirurg 106:272–280PubMedCrossRefGoogle Scholar
  26. 26.
    Thielke KH, Wagner T, Bartsch S, Echtermeyer V (2003) Angularly stable radius plate: progress in treatment of problematic diatal radius fracture? Chirurg 74:1057–1063PubMedCrossRefGoogle Scholar
  27. 27.
    Schmelzer-Schmied N, Widloch P, Martini AK, Daecke W (2009) Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly. Int Orthop 33:773–778PubMedCrossRefGoogle Scholar
  28. 28.
    Axelrod TS, McMurtry RY (1996) Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius. J Hand Surg Am 15:1–11CrossRefGoogle Scholar
  29. 29.
    Kambouroglou GK, Axelrod TS (1998) Complications of the AO/ASIF Titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Bone Surg Am 23:737–741CrossRefGoogle Scholar
  30. 30.
    Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 27:205–215PubMedCrossRefGoogle Scholar
  31. 31.
    Dobretz H, Kutscha-Lissberg E (2003) Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 27:1–6Google Scholar
  32. 32.
    Trumble TE, Schmitt SR, Vedder NB (1995) Factors affecting functional outcome of displaced intra-articular distal radius fractures. J hand Surg Am 19:325–340CrossRefGoogle Scholar
  33. 33.
    Anderson DD, Bell AL, Gaffney MB, Imbriglia JE (1996) Contact stress distributions in malreduced intra-articular distal radius fractures. J Orthop Trauma 10:331–337PubMedCrossRefGoogle Scholar
  34. 34.
    Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68:647–659PubMedGoogle Scholar
  35. 35.
    Kreder HJ, Hanel DP, McKee M, Jupiter J, McGilivary G, Swiontkowski MF (1996) X-ray film measurements for healed distal radius fractures. J Hand Surg Am 21:31–39PubMedCrossRefGoogle Scholar
  36. 36.
    Schuind F, Alemzadeh S, Stallenberg B, Burny F (1996) Does the normal contralateral wrist providethe best reference for X-ray film measurements of the pathologic wrist? J Hand Surg Am 21:24–30PubMedCrossRefGoogle Scholar
  37. 37.
    van der Linden W, Ericson R (1981) Colles’ fracture. How should its displacement be measured and how should it be immobilized? J Bone Surg Am 63:1285–1288PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Zhuang Cui
    • 1
  • Jianhong Pan
    • 2
  • Bin Yu
    • 1
  • Kairui Zhang
    • 1
  • Xiaolong Xiong
    • 1
  1. 1.Orthopaedics and traumaNanFang Hospital,Southern Medical UniversityGuangzhouChina
  2. 2.Department of BiostatisticsSchool of Public Health and Tropical Medicine, Southern Medical UniversityGuangzhouChina

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