Volar locking plate internal fixation and external fixator in repair of unstable distal radius fractures: randomized controlled trial

doi:10.3969/j.issn.2095-4344.2015.09.020

Abstract

Abstract:

BACKGROUND: Unstable distal radius fractures are the most common fractures of the human skeleton. Although various methods have demonstrated good results, the choice of the best option remains controversial.
OBJECTIVE: To investigate clinical outcomes, complications, and radiographic results of external fixation and open reduction and internal fixation with locking compression plate for repairing the unstable distal radius fractures using prospective randomized controlled method.
METHODS: From September 2011 to September 2013, 122 patients with the unstable distal radius fractures were enrolled in this prospective randomized study. These patients were randomized into two groups. The external fixation group (n=61) received closed reduction and external fixation. Plate group (n=61) received open reduction and internal fixation using a volar locking compression plate. Hospital days, fracture healing time, wrist function and complication rate were compared between the two groups. Quality of reduction was evaluated using imaging, including palmar angle, ulnar deviation, radial height and articular surface level.
RESULTS AND CONCLUSION: Follow-up time was 12-26 months in the external fixation group, and 12-28 months in the plate group. There was no significant difference in length of follow-up in both groups (P= 0.300). Clinical outcomes and imaging results were compared after treatment in both groups. Hospital days, fracture
healing time and postoperative recovery degree palmar angle were significantly larger in the plate group than in the external fixation group. No significant differences in ulnar deviation, radial height, wrist function, incidence of postoperative complications and articular surface level were detected between both groups (P > 0.05). Above findings suggested that for unstable distal radius fractures, the use of external fixation or volar locking plate treatment, can obtain satisfactory clinical outcomes, but the external fixation has the advantages of a less invasive, shorter hospital days, minor complications, faster fracture union, which is particularly suitable for treatment of the distal radius fracture in the elderly.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Radius, Fractures, Bone, Fracture Fixation, Internal Fixators, External Fixators

CLC Number:

R318

Li De-sheng, Li Hao-huan. Volar locking plate internal fixation and external fixator in repair of unstable distal radius fractures: randomized controlled trial[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1429-1434.

Figures/Tables 4

References

[1] 金粉勤,薛锋,徐雪荣,等.外固定支架与钢板内固定治疗桡骨远端不稳定型骨折的疗效比较[J].中华创伤骨科杂志,2013,15(1): 87-89.
[2] Porrino JA Jr, Maloney E, Scherer K, et al. Fracture of the distal radius: epidemiology and premanagement radiographic characterization. AJR Am J Roentgenol. 2014;203(3): 551-559.
[3] Kumbaraci M, Kucuk L, Karapinar L, et al. Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures. Eur J Orthop Surg Traumatol. 2014; 24(2):173-178.
[4] Moradi A, Ebrahimzadeh MH, Jupiter JB. Intra-articular fractures of the distal radius: bridging external fixation in slight flexion and ulnar deviation along articular surface instead of radial shaft. Tech Hand Up Extrem Surg. 2014; 18(1):41-50.
[5] Paksima N, Panchal A, Posner MA, et al. A meta-analysis of the literature on distal radius fractures: review of 615 articles. Bull Hosp Joint Dis. 2004;62(1-2):40-46.
[6] Bass RL, Blair WF, Hubbard PP. Results of combined internal and external fixation for the treatment of severe AO-C3 fractures of the distal radius. J Hand Surg.1995; 20(3): 373-381.
[7] Huch K, Hunerbein M, Meeder PJ. External fixation of intra-articular fracture of the distal radius in young and old adults. Arch Orthop Trauma Surg. 1996;115(1):38-42.
[8] Kawaguchi S, Sawada K, Nabeta Y, et al. Recurrent dorsal angulation of the distal radius fracture during dynamic external fixation. J Hand Surg Am. 1998; 23(5):920–925.
[9] Cronier P, Talha A, Toulemonde JL, et al. Results of distraction by way of external metacarporadial fixation in fracture of the distal end of the radius. Apropos of 97 cases. J Chir (Paris). 1991;128(1):8-12.
[10] Kandemir U, Matityahu A, Desai R, et al. Does a volar locking plate provide equivalent stability as a dorsal nonlocking plate in a dorsally comminuted distal radius fracture? A biomechanical study. J Orthop Trauma. 2008;22(9):605-610.
[11] 姜宗圆,马涛,夏江,等. 蝶形锁定钢板在复杂桡骨远端骨折中的应用[J]. 中国修复重建外科杂志,2014,28(6):665-668.
[12] Laulan J, Bismuth JP, Clément P,et al.An analytical classification of fractures of the distal radius: The "M.E.U." classification.Chir Main. 2007; 26(6):293-299.
[13] Cooney WP, Bussey R, Dobyns JH, et al. Difficult wrist fractures. Clin Orthop Relat Res. 1987;(214):136-147.
[14] Haus BM, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults: reexamined as evidence-based and outcomes medicine. J Bone Joint Surg Am. 2009;91(12): 2984-2991.
[15] Koo KO, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013;5(3):209-213.
[16] 殷兵,刘磊,陈伟,等.2003年至2012年河北医科大学第三医院成人尺桡骨远端骨折的流行病学研究[J].中华创伤骨科杂志, 2014, 16(4):316-319.
[17] Grewal R, MacDermid JC, King GJ, et al. Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg Am. 2011;36(12):1899-1906.
[18] Abramo A, Kopylov P, Geijer M, et al. Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: a randomized study of 50 patients. Acta Orthop. 2009;80(4):478-485.
[19] Grewal R, Perey B, Wilmink M, et al. 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. 2005;30(4): 764-772.
[20] Rozental TD, Blazar PE. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am. 2009; 91(8):1837-1846.
[21] Xu GG, Chan SP, Puhaindran ME, et al. Prospective randomised study of intra-articular fractures of the distal radius: comparison between external fixation and plate fixation. Ann Acad Med Singapore. 2009;38(7):600-606.
[22] 吕浩然,邹云雯,何二兴，等.两种方法治疗老年桡骨远端不稳定型骨折的疗效比较[J].中华创伤骨科杂志,2010,12(5):447-450.
[23] Kreder HJ, Hanel DP, Agel J, 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. 2005; 87(6):829-836.
[24] Leung F, Tu YK, Chew WY, et al. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study. J Bone Joint Surg Am. 2008; 90(1):16-22.
[25] MacDermid JC, Turgeon T, Richards RS, et al. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. 1998;12(8):57-586.
[26] Imaeda T, Uchiyama S, Wada T, et al. Reliability, validity, and responsiveness of the Japanese version of the Patient-Rated Wrist Evaluation. J Orthop Sci. 2010; 15(4):509-517.
[27] 杨召,马信龙,马剑雄,等.动态外固定架与静态外固定架治疗不稳定桡骨远端骨折远期疗效的Meta分析[J].中国矫形外科杂志, 2014,22(10):880-885.
[28] Tarallo L, Mugnai R, Zambianchi F, et al. Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma. 2013;27(12):740-745.