Comparison of External and Percutaneous Pin Fixation with Plate Fixation for Intra-articular Distal Radial Fractures: A Randomized Study

BackgroundThe most effective method for the fixation of an intra-articular distal radial fracture has not been established. Two commonly used treatment methods are external fixation combined with percutaneous pin fixation and plate fixation. We performed a prospective multicenter randomized trial to...

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Bibliographic Details
Published in:Journal of bone and joint surgery. American volume 2008-01, Vol.90 (1), p.16-22
Main Authors: Leung, Frankie, Tu, Yuan-kun, Chew, Winston Y.C, Chow, Shew-Ping
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Bone Nails
Bone Plates
Chi-Square Distribution
Diseases of the osteoarticular system
External Fixators
Female
Follow-Up Studies
Fracture Fixation, Internal - instrumentation
Fracture Fixation, Internal - methods
Fracture Healing - physiology
Humans
Injuries of the limb. Injuries of the spine
Injury Severity Score
Male
Medical sciences
Middle Aged
Orthopedic surgery
Probability
Prospective Studies
Radiography
Radius Fractures - diagnostic imaging
Radius Fractures - surgery
Range of Motion, Articular - physiology
Recovery of Function
Reference Values
Risk Assessment
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Traumas. Diseases due to physical agents
Treatment Outcome
Wrist Injuries - diagnostic imaging
Wrist Injuries - surgery
Wrist Joint - physiopathology
Wrist Joint - surgery
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Summary:BackgroundThe most effective method for the fixation of an intra-articular distal radial fracture has not been established. Two commonly used treatment methods are external fixation combined with percutaneous pin fixation and plate fixation. We performed a prospective multicenter randomized trial to compare these two treatment strategies.MethodsA total of 137 patients with 144 intra-articular distal radial fractures were recruited into the study. The average age of the patients was forty-two years, and all patients were sixty years old or less. The patients were randomized to fracture fixation with one of the two methods. At six, twelve, and twenty-four months postoperatively, the patients were assessed with use of the Gartland and Werley point system and the modified Green and OʼBrien scoring system. Arthritis was graded on radiographs according to a modification of the Knirk and Jupiter criteria.ResultsSeventy-four (51%) of the fractures were treated with external fixation and percutaneous pin fixation, and seventy were treated with dorsal, volar, or combined plate fixation. At the time of the twenty-four-month follow-up, the results for the plate fixation group were significantly better than those for the external fixation and percutaneous pin fixation group according to the Gartland and Werley point system (p = 0.04) and the radiographic arthritis grading system (p = 0.01). The difference was especially notable among patients with AO group-C2 fractures.ConclusionsPlate fixation is better than external fixation combined with percutaneous pin fixation for the treatment of intra-articular fractures of the distal part of the radius.Level of EvidenceTherapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
ISSN:0021-9355
1535-1386
DOI:10.2106/JBJS.F.01581