Department of Orthopedics, Clinical Sciences, Lund University, Lund Sweden, Acta Orthopaedica 2009; 80 (3): 478-485
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 strenght 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* (15) in the internal fixation group and 136* (20) in the external fixation at 1 year. There were no differences in DASH scoresor in radiographic parameters. 5 patients in the external fixation group were reoprated 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 strenght and a better grip strenght 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.