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Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF

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Abstract

The purpose of this study was to determine the most appropriate surgical treatment from three procedures used for fractures of the distal radius. In a retrospective comparative study, 166 out of 237 patients who underwent surgery for AO/ASIF A3 or C2 distal radius fractures were evaluated. Surgical procedures were external fixation or open reduction and internal fixation with either palmar or dorsal plates. Radiological outcomes were palmar tilt, radial angle, radial length and ulnar variance. Functional outcomes were range of motion and grip strength. In addition, outcomes according to Gartland and Werley and the Disabilities of the Arm, Shoulder and Hand questionnaire were compared. Further outcome criteria were the treatment time and the number of complications. Data were analysed using an analysis of variance statistical procedure respective of the χ2-test. Open reduction and internal fixation, in particular palmar plate fixation, demonstrated the best radiological and functional results. Subjective assessment of ORIF proved better than that of external fixation as treatment time was shorter and complications were more rarely seen. However, most of the differences between groups were not significant. Although there were no significant differences between groups, our data indicates that most dorsally displaced distal radius fractures can be treated successfully by open reduction and internal fixation. Palmar plate fixation seems to have slight advantages compared to both the external fixation and dorsal plate fixation surgical procedure.

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References

  1. Altissimi M, Mancini GB, Ciaffoloni E, Pucci G (1991) Comminuted articular fractures of the distal radius. Results of conservative treatment. Ital J Orthop Traumatol 17:117–123

    PubMed  CAS  Google Scholar 

  2. Amadio PC (1997) Outcomes assessment in hand surgery. Whatȁ9s new? Clin Plast Surg 24:191–194

    PubMed  CAS  Google Scholar 

  3. Ark J, Jupiter JB (1993) The rationale for precise management of distal radius fractures. Orthop Clin North Am 24:205–210

    PubMed  CAS  Google Scholar 

  4. Campbell DA (2000) Open reduction and internal fixation of intra articular and unstable fractures of the distal radius using the AO distal radius plate. J Hand Surg Br 25:528–534

    Article  PubMed  CAS  Google Scholar 

  5. Carter PR, Frederick HA, Laseter GF (1998) Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg Am 23:300–307

    PubMed  CAS  Google Scholar 

  6. Castaing J (1964) Recent fractures of the lower extremity of the radius in adults. Rev Chir Orthop Reparatrice Appar Mot 50:581–696

    PubMed  CAS  Google Scholar 

  7. Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H (1999) Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg Am 81:1093–1110

    PubMed  CAS  Google Scholar 

  8. Finsen V, Aasheim T (2000) Initial experience with the Forte plate for dorsally displaced distal radius fractures. Injury 31:445–448

    PubMed  CAS  Google Scholar 

  9. Franck WM, Dahlen C, Amlang M, Friese F, Zwipp H (2000) Distale Radiusfraktur - Ist der nicht-gelenküberbrückende Fixateur externe eine therapeutische Alternative? Eine prospektiv randomisierte Studie. Unfallchirurg 103:826–833

    Article  PubMed  CAS  Google Scholar 

  10. Gartland JJ, Werley CW (1951) Evaluation of healed Collesȁ9 fractures. J Bone Joint Surg Am 33:895–907

    PubMed  Google Scholar 

  11. Geissler WB, Freeland AE (1996) Arthroscopically assisted reduction of intraarticular distal radial fractures. Clin Orthop 327:125–134

    Article  PubMed  Google Scholar 

  12. Germann G, Wind G, Harth A (1999) Der DASH-Fragebogen - Ein neues Instrument zur Beurteilung von Behandlungsergebnissen an der oberen Extremitat. Handchir Mikrochir Plast Chir 31:149–152

    Article  PubMed  CAS  Google Scholar 

  13. Gliatis JD, Plessas SJ, Davis TR (2000) Outcome of distal radial fractures in young adults. J Hand Surg Br 25:535–543

    PubMed  CAS  Google Scholar 

  14. Handoll HH, Madhok R (2003) Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev CD003209

  15. Herron M, Faraj A, Craigen MA (2003) Dorsal plating for displaced intra-articular fractures of the distal radius. Injury 34:497–502

    Article  PubMed  CAS  Google Scholar 

  16. Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B (2002) The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 84-A:208–215

    PubMed  Google Scholar 

  17. Jakim I, Pieterse HS, Sweet MB (1991) External fixation for intra-articular fractures of the distal radius. J Bone Joint Surg Br 73:302–306

    PubMed  CAS  Google Scholar 

  18. Jakob M (1999) Therapieergebnisse nach primär konservativer Versorgung distaler Radiusfrakturen bei Patienten im Alter von über 65 Jahren. Handchir Mikrochir Plast Chir 31:241–245

    Article  PubMed  CAS  Google Scholar 

  19. Jenkins NH, Jones DG, Johnson SR, Mintowt-Czyz WJ (1987) External fixation of Collesȁ9 fractures. An anatomical study. J Bone Joint Surg Br 60:207

    Google Scholar 

  20. Jupiter JB (1991) Fractures of the distal end of the radius. J Bone Joint Surg Am 73:461–469

    PubMed  CAS  Google Scholar 

  21. Jupiter JB, Ring D, Weitzel PP (2002) Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg Am 27:714–723

    Article  PubMed  Google Scholar 

  22. Kamano M, Honda Y, Kazuki K, Yasuda M (2002) Palmar plating for dorsally displaced fractures of the distal radius. Clin Orthop 397:403–408

    PubMed  Google Scholar 

  23. Kambouroglu 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 Hand Surg Am 23:737–741

    PubMed  Google Scholar 

  24. 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 31:75–79

    PubMed  CAS  Google Scholar 

  25. Klein W, Dee W, Rieger H, Neumann H, Joosten U (2000) Results of transarticular fixator application in distal radius fractures. Injury 31(Suppl 1):71–77

    Article  PubMed  Google Scholar 

  26. Konrath GA, Bahler S (2002) Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system. J Orthop Trauma 16:578–585

    Article  PubMed  Google Scholar 

  27. Leung KS, Shen WY, Tsang HK, Chiu KH, Leung PC, Hung LK (1990) An effective treatment of comminuted fractures of the distal radius. J Hand Surg Am 15:11–17

    PubMed  CAS  Google Scholar 

  28. Ludvigsen TC, Johansen S, Svenningsen S, Saetermo R (1997) External fixation versus percutaneous pinning for unstable Collesȁ9 fracture. Equal outcome in a randomized study of 60 patients. Acta Orthop Scand 68:255–258

    Article  PubMed  CAS  Google Scholar 

  29. MacDermid JC, Donner A, Richards RS, Roth JH (2002) Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture. J Clin Epidemiol 55:849–854

    Article  PubMed  Google Scholar 

  30. McQueen M, Caspers J (1988) Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg Br 70:649–651

    PubMed  CAS  Google Scholar 

  31. Meier R, Krettek C, Krimmer H (2003) Bildgebende Verfahren am Handgelenk. Unfallchirurg 106:999–1009

    Article  PubMed  CAS  Google Scholar 

  32. Neumann K, Clarius M, Gutsfeld P (1996) Fixateur extern oder Spickdrahtosteosynthesen bei instabilen distalen intraartikulären Radiusfrakturen älterer Patienten. Langenbecks Arch Chir Suppl Kongressbd 113:912–913

    PubMed  CAS  Google Scholar 

  33. Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 27:205–215

    Article  PubMed  Google Scholar 

  34. Peicha G, Fellinger M, Seibert FJ, Grechenig W, Schippinger G (1997) Skapholunäre Bandverletzungen beim akuten Handgelenktrauma. Arthroskopische Diagnose und minimal-invasive Therapie. Unfallchirurg 100:430–437

    Article  PubMed  CAS  Google Scholar 

  35. Ring D, Jupiter JB, Brennwald J, Buchler U, Hastings H (1997) Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg Am 22:777–784

    PubMed  CAS  Google Scholar 

  36. Rommens PM, Vanderschot PM, Broos PL (1992) External fixation of the distal end of the radius: the same technique for different patient populations? Arch Orthop Trauma Surg 111:165–170

    Article  PubMed  CAS  Google Scholar 

  37. Rozental TD, Beredjiklian PK, Bozentka DJ (2003) Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg Am 85:1956–1960

    PubMed  Google Scholar 

  38. Ruch DS, Vallee J, Poehling GG, Smith BP, Kuzma GR (2004) Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy 20:225–230

    Article  PubMed  Google Scholar 

  39. Ruch DS, Yang CC, Smith BP (2003) Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-articular distal radius fractures. Arthroscopy 19:511–516

    Article  PubMed  Google Scholar 

  40. Sakhaii M, Groenewold U, Klonz A, Reilmann H (2003) Ergebnisse nach palmarer Plattenosteosynthese mit der winkelstabilen T-Platte bei 100 distalen Radiusfrakturen. Eine prospektive Studie. Unfallchirurg 106:272–280

    Article  PubMed  CAS  Google Scholar 

  41. Seitz WH, Putnam MD, Dick HM (1990) Limited open surgical approach for external fixation of distal radius fractures. J Hand Surg Am 15:288

    PubMed  Google Scholar 

  42. Seitz WH Jr, Froimson AI, Leb R, Shapiro JD (1991) Augmented external fixation of unstable distal radius fractures. J Hand Surg Am 16:1010–1016

    Article  PubMed  Google Scholar 

  43. Steffen T, Eugster T, Jakob RP (1994) Twelve years follow-up of fractures of the distal radius treated with the AO external fixator. Injury 25 (Suppl 4):S-54

    Google Scholar 

  44. Sun JS, Chang CH, Wu CC, Hou SM, Hang YS (2001) Extra-articular deformity in distal radial fractures treated by external fixation. Can J Surg 44:289–294

    PubMed  CAS  Google Scholar 

  45. Thielke KH, Wagner T, Bartsch S, Echtermeyer V (2003) Winkelstabile, volare Plattenosteosynthese komplexer artikulärer Frakturen am distalen Radius. Lösung einer Problemfraktur? Chirurg 74:1057–1063

    Article  PubMed  Google Scholar 

  46. Yen ST, Hwang CY, Hwang MH (1991) A semiinvasive method for articular Collesȁ9 fractures. Clin Orthop 263:154–164

    PubMed  Google Scholar 

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Correspondence to Thomas Westphal.

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Westphal, T., Piatek, S., Schubert, S. et al. Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF. Arch Orthop Trauma Surg 125, 507–514 (2005). https://doi.org/10.1007/s00402-005-0023-3

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