Temporary external fixation versus direct ORIF in complete displaced intra-articular radius fractures

Objectives It is common practise to use either direct definitive plate fixation or temporary external fixation as a bridge to definitive fixation in complex distal radius fractures (DRF). It is however unclear which is better with regards to functional and radiological outcomes. The hypothesis of this study was that the two-staged principle results in better outcomes.

Methods This prospective observational study included all patients presenting with AO OTA C2 or C3 DRF between January 2011 and January 2018. All patients were categorized into two groups according to received treatment: Patients who underwent direct definitive osteosynthesis (Group ORIF) and patients who received an external fixator followed by definitive fixation (Group

Fx-ORIF). Primary outcome was the PRWE measured at one year follow-up. Secondary outcomes included Range of Motion (ROM) and radiologic parameters (ulnar variance, radial inclination and volar tilt).

Results and Conclusion Results: A total of 187 patients were included in Group ORIF with a mean age of 55.6 years (SD 17.2), of which 112 had a C2 and 75 a C3 fracture. The Fx-ORIF group consisted of 66 patients with a mean age of 53.7 years (SD 20.4 years), of which 30 patients having a C2 and 36 had a C3 fracture. There was no significant difference in median PRWE between de Group ORIF (12.0, IQR 2.0 - 20.0) and Fx-ORIF group (12.2, IQR 5.5 - 23.4) (p=0.189). After corrections for C2/3 and open/closed fractures the difference remained insignificant. The ROM and radiologic parameters did not show any significant differences.

Conclusion: No differences were found in clinical and radiological outcome between one or two staged surgical technique, probably because two staged surgery was the preferred technique in the most complex fractures. Further research needs to be done to explore the advantages of better planning and analgesia versus the higher costs and impact of a second operation.

Stichwörter Distal radius fracture, external fixator, ORIF, PRWE

Publication History

Article published online:
15 October 2020