Nonbridging external fixation comparable to volar plating for distal radius fractures

Prospective, randomized trial finds that external fixation is also suitable in osteoporosis patients.

Issue: Issue 2 2007

WASHINGTON – Despite a growing trend toward open reduction and internal fixation of unstable distal radius fractures, some German researchers are proving that external fixation still has its place.

Early results from a German study demonstrated that nonbridging external fixation produces comparable results to volar plating of these fractures while permitting better volar tilt. Georg Gradl, MD, of Rostock, Germany, presented the prospective, randomized study at the American Society for Surgery of the Hand annual meeting.

“The external fixation had significantly shorter operation time,” Gradl said. “The 8-week results showed that the external fixation patients had less pain and less grip strength when compared to the opposite side. But in the long run, there was no difference between both procedures.”

Proving that there remains a place for external fixation, researchers found comparable results between this technique and open reduction and internal fixation, with external fixation patients having shorter operating time and less initial pain.

Images: Gradl G

Patient groups

Gradl and his colleagues enrolled 102 patients in the study. Patients were mostly women (89) and a mean age of 63 years. Overall, the patient group included 62 extra-articular and 40 articular fractures, and the researchers distributed them evenly between the two groups, he said.

They randomized 52 patients to the plate osteosynthesis (PO) group and treated them with a 2.4-mm angular stable plate, according to a study abstract.

Surgeons treated the remaining 50 patients with primary joint bridging and external fixation to help restore radial length, and then implanted 1.8-mm K-wires, Gradl said. Surgeons removed the external fixation at 7 weeks postoperatively.

Better volar tilt with fixation

The average operating time for external fixation was roughly 43 minutes, compared to about 58 minutes for the PO group (P<.05), according to the study abstract.

On the radiological evaluation, the researchers found 0.5 ± 0.7 mm of radial shortening for the external fixation patients and 0.20 ±.1 mm of radial shortening in the PO patients (P<.05).

“There were no cases of radial shortening more than 3 mm,” Gradl said. The mean volar tilt was 7.2° ± 5° for the nonbridging external fixation and 0.1° ± 0.5° for the volar plating (P<.001).

At 8 weeks, flexion and extension reached an average of 66% of the uninjured side, and the function was almost completely restored at 12 months, Gradl said.

Patients with osteoporosis

Researchers also found that nonbridging external fixation is an appropriate treatment for osteoporosis patients. “Forty percent of patients in each group had osteoporotic bone and it had no influence on the functional and radiographic outcome,” Gradl said.

Complications included six mild cases of Type 1 complex regional pain syndrome and six pin infections that were treated with local pin care.

Although the researchers discouraged implant removal, nine patients requested plate removal because of discomfort.

$Gradl and colleagues treated the distal radius fracture$
Gradl and colleagues treated the distal radius fractures with a nonbridging external fixation technique using multiplanar K-wires.

Patient reached flexion and extension of 66%
At 8 weeks, patients with external fixation reached flexion and extension of 66% compared to the uninjured side. Function was nearly restored at 12 months.

For more information:
Gradl G, Jupiter JB, Wendt M, et al. A prospective randomized trial of nonbridging external fixation using multiplanar K-wires versus volar plating for unstable fractures of the distal radius. #26. Presented at the American Society for Surgery of the Hand 61st Annual Meeting. Sept. 7-9, 2006. Washington.
Georg Gradl, MD, University of Rostock, Schillingallee 35, 18055 Rostock, Germany; +49-381-494-6051; ggradl@t-online.de. He indicated that he has no financial conflict of interest with any product or company mentioned in this article.