Comparison of outcome of fracture distal end radius treated by external fixator versus volar plating

Abstract

Introduction: Distal Radius Fractures occur with a high frequency and continue to be most common skeletal injuries treated by orthopedic surgeon and these injuries accounting for approximately one sixth of all fractures seen in emergency. As fractures occur through cancellous bone union is not a problem. All the treatment is aimed towards anatomical reduction to prevent malunion and achieve good functional results. This study was aimed to compare the relative efficacy of external fixation versus plating with regard to functional and radiological outcome. Material and method: A prospective comparative study was conducted, studying 50 cases of unstable distal end radius fractures who were fitting in the inclusion criteria. It followed AO classification to classify cases and then compare the various outcomes to get the better modality of treatment with an average follow-up of 11 months. The two groups were compared for clinical and functional outcomes measured by MAYO score. Radiographic measurements were also evaluated between groups. Results: Final ranges of motion and grip strengths were better in ORIF group as compared to External Fixation. The mean MAYO score of the locked volar plate group was 85 compared to 78 for the external fixation group. Radiographically, volar tilt and radial length were significantly better in the patients treated with ORIF. No complications occurred in the locked volar plate group whereas three patients had pin tract infections and two had prolonged finger stiffness in the external fixation group. Conclusion: We concluded that fracture fixation with volar plate and screw system in the management of distal radius articular fractures, is a superior method to maintain the reduction till union and prevent the collapse of the fracture fragments, even in grossly comminuted, unstable and osteoporotic bones; as compared with external fixator. Whereas grip strength, range of motion, MAYO scores, frequency of rehabilitation, and some radiographic parameters were superior in patients treated with ORIF.