Effectiveness and Safety of External Fixation versus Open Reduction and Internal Fixation for the Adults’ Unstable Distal Radius Fractures: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 CHEN Ming ¹ , ZHAO Jingming ² , LI Bing ¹ , PENG Xiaozhong ¹ , DING Xiaofei ² , SU Wei ² , SHA Ke ² , SHI Zhanying ¹ , WU Zhenguo ¹

1. No. 2 Department of Orthopedics, the Worker’s Hospital of Guangxi, Liuzhou 545005, China; 2. The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China;

Corresponding author：

CHEN Ming, Email: zhaojingmin@126.com

Keywords：

Distal radius fractures; External fixation; Open reduction and internal fixation; Adults; Randomized controlled trial; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20100583

Video：

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Objective 　To evaluate the effectiveness and safety of external fixation (EF) and open reduction and internal fixation (ORIF) for unstable distal radius fractures in adults.
Methods 　We searched MEDLINE (1966 to September 2008), Cochrane Central register of controlled Trials (The Cochrane Library, Issue 3, 2008), EMbase (1974 to September 2008), CBM, CNKI, and collected randomized controlled trials (RCTs) of EF and ORIF for unstable distal radius fractures in adults. The quality of the included studies was critically assessed and data analyses were performed with the Cochrane Collaboration’s RevMan 5.0 software.
Results 　Seven RCTs involving 634 patients were included, of which 269 were in EF group, and 293 were in ORIF group. Only 1 study had relative high quality, all the others had some limitation in randomization, blinding, and allocation concealment. The results of meta-analyses showed that, 1) about the effectiveness: according to the Gartland and Werley grade standard, the ORIF group was better than the EF group with statistic difference (RR=1.50, 95%CI 1.11 to 2.03, P=0.008); because of the original studies did not offer the detailed data including pad strength, grip strength, flexion-extension, radial deviation, and ulnar deviation, we only processed a descriptive analysis; and 2) about complications: the infection rate of the pin track was higher in the EF group than that in the ORIF group with statistic difference (RR=0.24, 95%CI 0.08 to 0.76, P=0.02); but there were no differences between the two groups in reflex sympathetic dystrophy (RSD) (RR=0.88, 95%CI 0.30 to 2.56, P=0.82), extensor tendon rupture (RR=3.93, 95%CI 0.45 to 34.62, P=0.22), and compartment syndrome (RR=3.13, 95%CI 0.51 to 19.09, P=0.22).
Conclusions 　Compared with EF, ORIF is much better based on Gartland and Werley grade standard, and causes much less infection. Because of the limited quality and quantity of the included studies, more proofs are required from more RCTs with large sample.

Citation： CHEN Ming,ZHAO Jingming,LI Bing,PENG Xiaozhong,DING Xiaofei,SU Wei,SHA Ke,SHI Zhanying,WU Zhenguo,YANG Zhixian,SHI Dan,WEI Hanyu. Effectiveness and Safety of External Fixation versus Open Reduction and Internal Fixation for the Adults’ Unstable Distal Radius Fractures: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(11): 1269-1275. doi: 10.7507/1672-2531.20100583 Copy

1.	于吉胜, 蔡锦方. 腕关节外科学. 北京: 人民卫生出版社, 2002: 241.
2.	Edwards CC 2nd, Haraszti CJ, Mcillivary GR, et al. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am, 2001, 26(6): 1036-1041.
3.	Kamano M, Honda Y, Kazuki K. Palmar plating for dorsally displaced fractures of the distal radius. Zentralbl Chir, 2003, 128(12): 997-1002.
4.	Lee HC, Wong YS, Chan BK, et al. Fixation of distal radius fractures Using AOtitanium volar distal radius plate. Hand Surg, 2003, 8(1): 7-15.
5.	Ring D, Prommersberger K, Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg, 2004, 86-A(8): 1646-1652.
6.	Konrath GA, Bahler S. Open reduction and internal fixation of unstable distal radius fractures: results using the TriMed fixation system. J Orthop Trauma, 2002, 16(8): 578-585.
7.	Wiesler ER, Chloros GD, Lucas RM. Arthroscopic management of volar lunate facet fractures of the distal radius. Tech Hand Up Extrem Surg, 2006, 10(3): 139-144.
8.	Rogachefsky RA, Lipson SR, Applegate B, et al. Treatment of severely comminuted intraarticular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Joint Surg, 2001, 83-A(4): 509-519.
9.	Constantine KJ, Clawson MC, Stern PJ. Volar neutralization plate fixation of dorsally displaced distal radius fractures. Orthopedics, 2002, 25(2): 125-128.
10.	Gartland JJ Jr, Werley CW. Evaluation of healed colles fractures. J Bone Joint Surg Am, 1951, 33-A(4): 895-907.
11.	Trumble TE, Schmitt SR, Vedder NB. Factors affecting Functional outcome of displaced intra-articular distal radius fractures. J Hand Surg, 1994, 19(2): 325-340.
12.	Axelrod T, Paley D, Green J. Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius. J Hand Surg, 1988, 13(3): 372-277.
13.	Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg, 1989, 71(6): 839-847.
14.	Jupiter JB, Lipton H. The operative treatment of intraarticular fractures of the distal radius. Clin Orthop, 1993, (292): 48-61.
15.	Gesensway D, Putnam MD, Mente PL, et al. Design and biomechanics of a plate for the distal radius. J Hand Surg, 1995, 20(6):1021-1027.
16.	Ring D, Jupiter JB. Operative fixation of fractures of the distal radius using the plate. Tech Hand Upper Extremity Surg, 1997, 1(2): 125-130.
17.	Higgins JPT, Altman DG. Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane- handbook.org.
18.	吴泰相, 刘关健. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
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 verse mini open reduction, and external fixation. J Hand Surg Am, 2005, 30(4): 764-772.
20.	Kreder HJ, Hanel DP, Agel J. Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius a radomised, controlled trial. Bone Joint Surg [Br], 2005, 87(6): 829-836.
21.	McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br, 1996, 78(3): 404-409.
22.	Leung F, Tu YK, Chew WYC, 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.
23.	Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury, 2000, 31(2): 75-79.
24.	马楚平, 何光联, 梁江山, 等. 桡骨外固定器和钢板内固定治疗桡骨远端不稳定骨折的效果比较. 广东医学院学报, 2008, 26(4): 24-26.
25.	Handoll HHG, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev, 2009, 8(3): CD003209.

1. 于吉胜, 蔡锦方. 腕关节外科学. 北京: 人民卫生出版社, 2002: 241.
2. Edwards CC 2nd, Haraszti CJ, Mcillivary GR, et al. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am, 2001, 26(6): 1036-1041.
3. Kamano M, Honda Y, Kazuki K. Palmar plating for dorsally displaced fractures of the distal radius. Zentralbl Chir, 2003, 128(12): 997-1002.
4. Lee HC, Wong YS, Chan BK, et al. Fixation of distal radius fractures Using AOtitanium volar distal radius plate. Hand Surg, 2003, 8(1): 7-15.
5. Ring D, Prommersberger K, Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg, 2004, 86-A(8): 1646-1652.
6. Konrath GA, Bahler S. Open reduction and internal fixation of unstable distal radius fractures: results using the TriMed fixation system. J Orthop Trauma, 2002, 16(8): 578-585.
7. Wiesler ER, Chloros GD, Lucas RM. Arthroscopic management of volar lunate facet fractures of the distal radius. Tech Hand Up Extrem Surg, 2006, 10(3): 139-144.
8. Rogachefsky RA, Lipson SR, Applegate B, et al. Treatment of severely comminuted intraarticular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Joint Surg, 2001, 83-A(4): 509-519.
9. Constantine KJ, Clawson MC, Stern PJ. Volar neutralization plate fixation of dorsally displaced distal radius fractures. Orthopedics, 2002, 25(2): 125-128.
10. Gartland JJ Jr, Werley CW. Evaluation of healed colles fractures. J Bone Joint Surg Am, 1951, 33-A(4): 895-907.
11. Trumble TE, Schmitt SR, Vedder NB. Factors affecting Functional outcome of displaced intra-articular distal radius fractures. J Hand Surg, 1994, 19(2): 325-340.
12. Axelrod T, Paley D, Green J. Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius. J Hand Surg, 1988, 13(3): 372-277.
13. Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg, 1989, 71(6): 839-847.
14. Jupiter JB, Lipton H. The operative treatment of intraarticular fractures of the distal radius. Clin Orthop, 1993, (292): 48-61.
15. Gesensway D, Putnam MD, Mente PL, et al. Design and biomechanics of a plate for the distal radius. J Hand Surg, 1995, 20(6):1021-1027.
16. Ring D, Jupiter JB. Operative fixation of fractures of the distal radius using the plate. Tech Hand Upper Extremity Surg, 1997, 1(2): 125-130.
17. Higgins JPT, Altman DG. Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane- handbook.org.
18. 吴泰相, 刘关健. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
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 verse mini open reduction, and external fixation. J Hand Surg Am, 2005, 30(4): 764-772.
20. Kreder HJ, Hanel DP, Agel J. Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius a radomised, controlled trial. Bone Joint Surg [Br], 2005, 87(6): 829-836.
21. McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br, 1996, 78(3): 404-409.
22. Leung F, Tu YK, Chew WYC, 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.
23. Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury, 2000, 31(2): 75-79.
24. 马楚平, 何光联, 梁江山, 等. 桡骨外固定器和钢板内固定治疗桡骨远端不稳定骨折的效果比较. 广东医学院学报, 2008, 26(4): 24-26.
25. Handoll HHG, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev, 2009, 8(3): CD003209.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of External Fixation versus Open Reduction and Internal Fixation for the Adults’ Unstable Distal Radius Fractures: A Systematic Review

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