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

Abramo A, Kopylov P, Geijer M, Tägil M - Acta Orthop (2009)

Bottom Line: The type of operation and the choice of implant, however, is a matter of discussion.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.No difference could be found regarding subjective outcome.

View Article: PubMed Central - PubMed

Affiliation: Hand Unit, Department of Orthopedics, Clinical Sciences, Lund University, Sweden. tony.abramo@med.lu.se

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.

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AP and lateral radiographs of a patient operated using closed reduction and external fixation.
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Figure 0002: AP and lateral radiographs of a patient operated using closed reduction and external fixation.

Mentions: Closed reduction and external fixation (C). The external fixator used for the first 20 patients was the Hoffman type-1 bridging external fixator (Stryker, Hopkinton, MA), which was changed to the Radio Lucent Wrist Fixator (Orthofix Srl, Bussolengo, Italy) by the start of 2005 and used in the last 4 patients. Pins were inserted into the second metacarpal and into the radius proximally to the fracture. Clamps were attached to the pins and the fracture was reduced and fixated with a steel rod between the clamps (Figure 2). In comminuted fractures with a bone defect and when additional stability was desired, K-wires were inserted percutaneously. A bone graft substitute (Norian SRS), also inserted percutaneously, was used at the surgeons' discretion (2 patients). The fixator was usually removed after 5–6 weeks and thereafter active mobilization was started under the supervision of a physiotherapist. There was no restriction regarding pronation or supination during the fixation time in either of the groups.


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

Abramo A, Kopylov P, Geijer M, Tägil M - Acta Orthop (2009)

AP and lateral radiographs of a patient operated using closed reduction and external fixation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823185&req=5

Figure 0002: AP and lateral radiographs of a patient operated using closed reduction and external fixation.
Mentions: Closed reduction and external fixation (C). The external fixator used for the first 20 patients was the Hoffman type-1 bridging external fixator (Stryker, Hopkinton, MA), which was changed to the Radio Lucent Wrist Fixator (Orthofix Srl, Bussolengo, Italy) by the start of 2005 and used in the last 4 patients. Pins were inserted into the second metacarpal and into the radius proximally to the fracture. Clamps were attached to the pins and the fracture was reduced and fixated with a steel rod between the clamps (Figure 2). In comminuted fractures with a bone defect and when additional stability was desired, K-wires were inserted percutaneously. A bone graft substitute (Norian SRS), also inserted percutaneously, was used at the surgeons' discretion (2 patients). The fixator was usually removed after 5–6 weeks and thereafter active mobilization was started under the supervision of a physiotherapist. There was no restriction regarding pronation or supination during the fixation time in either of the groups.

Bottom Line: The type of operation and the choice of implant, however, is a matter of discussion.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.No difference could be found regarding subjective outcome.

View Article: PubMed Central - PubMed

Affiliation: Hand Unit, Department of Orthopedics, Clinical Sciences, Lund University, Sweden. tony.abramo@med.lu.se

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.

Show MeSH
Related in: MedlinePlus