Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: a randomized study of 50 patients.

Abstract:

BACKGROUND AND PURPOSE:In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation. METHODS:50 patients with an unstable or comminute distal radius fracture were randomized to either closed reduction and bridging external fixation, or open reduction and internal fixation using the TriMed system. The primary outcome parameter was grip strength, but the patients were followed for 1 year with objective clinical assessment, subjective outcome using DASH, and radiographic examination. RESULTS:At 1 year postoperatively, grip strength was 90% (SD 16) of the uninjured side in the internal fixation group and 78% (17) in the external fixation group. Pronation/supination was 150 degrees (15) in the internal fixation group and 136 degrees (20) in the external fixation group at 1 year. There were no differences in DASH scores or in radiographic parameters. 5 patients in the external fixation group were reoperated due to malunion, as compared to 1 in the internal fixation group. 7 other cases were classified as radiographic malunion: 5 in the external fixation group and 2 in the internal fixation group. INTERPRETATION:Internal fixation gave better grip strength and a better range of motion at 1 year, and tended to have less malunions than external fixation. No difference could be found regarding subjective outcome.

journal_name

Acta Orthop

journal_title

Acta orthopaedica

authors

Abramo A,Kopylov P,Geijer M,Tägil M

doi

10.3109/17453670903171875

subject

Has Abstract

pub_date

2009-08-01 00:00:00

pages

478-85

issue

4

eissn

1745-3674

issn

1745-3682

pii

10.3109/17453670903171875

journal_volume

80

pub_type

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