Functional outcome of external fixator application vs volar plating for intrarticular distal radius fractures: A long term prospective study

Abstract

Fractures of distal end radius are common fractures of the upper limb, and constitute 17% of all fractures and 75% of all forearm fractures. This fracture shows bimodal distribution of age with the fracture more commonly seen in children and elderly. Fractures that involve the articular surfaces of the distal radius can jeopardize the congruence and kinematics of the wrist joint. Anatomical articular reduction greatly reduces the incidence of post-traumatic osteoarthrosis and the quality of reduction relates directly to the final outcome. These types of fractures have been treated by various methods. Many fixation techniques have been described including pin and plaster fixation, percutaneous pinning, intramedullary pinning, external fixation (bridging or nonbridging, static or dynamic) and various forms of internal fixation with customised implants. The advantages of external fixation are the relative ease of application, minimal surgical exposure, and reduced surgical trauma. The disadvantages are prolonged immobilisation of the radiocarpal joint, indirect reduction of fracture fragments, loss of ligamentotaxis over time, and pin related complications. The advantages of plate osteosynthesis are direct fracture reduction, stable rigid fixation, and the possibility of immediate postoperative motion. Open reduction of the fracture allows reduction of the fracture under direct vision and should lead to accurate restoration of anatomy. Dorsal plates were associated with tendon rupture, tenosynovitis, reoperation, and 25% of collapse while the complication of volar plating is relatively low. The volar surface of the distal radius may be biologically more acceptable for open reduction and internal fixation than the dorsal surface because the flexor tendons are not as close to the bone sur faceas the extensor tendons.