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ORIF for distal radius fractures shows advantages over closed reduction
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CHICAGO — Results from a randomized trial comparing open reduction and internal fixation (ORIF) against closed reduction for distal radius fractures has found short- and long-term advantages in grip strength and range of motion for the open procedure, but no differences in Disabilities of the Arm, Shoulder and Hand (DASH) scores between the two approaches at 1 year.
Investigators randomized 50 patients to receive ORIF or closed reduction with external fixation within 10 days of experiencing an unstable or complex distal radius fracture.
“The randomization was done by closed envelopes in the operating room,” Antonio Abramo, MD, of Lund, Sweden, said at the 63rd Annual Meeting of the American Society for Surgery of the Hand, here.
Patients ranged in age from 18 to 65 years old. The patients were followed prospectively for 1 year with objective clinical assessment, subjective outcome using DASH, and radiographic examination, he said.
Patients randomized to the ORIF group received the TriMed Wrist System (TriMed) with bone grafting or bone substitutes, Abramo said.
“There were 24 patients in the external fixation group and 26 in the internal fixation group,” he said. “The fracture type and preoperative DASH scores were the same in both groups.”
Abramo reported that at 7 weeks postoperative, the ORIF group had a higher mean grip strength compared to the closed reduction group, and the mean range of motion in flexion/extension and forearm rotation was also larger in the ORIF group. “However, there was no difference in DASH scores,” he said.
Follow-up at 1 year showed that the difference in grip strength and forearm rotation between the groups remained. The DASH scores continued to be similar.
“There were a lot more complications with the external fixation group,” Abramo said. Overall, five patients in the external fixation group were re-operated for malunion, compared to one in the ORIF group.
“In the short term, open reduction and internal fixation gave better grip strength, forearm rotation and flexion/extension,” he said. “In the long-term, the difference in grip strength and forearm rotation remains.”
For more information:
- Abramo A, Tagil M, Kopylov, P, Geijer M. Open reduction and internal fixation versus closed reduction and external fixation in distal radius fractures: A randomized study. Paper 35. Presented at the 63rd Annual Meeting of the American Society for Surgery of the Hand. Sept. 18-20, 2008. Chicago.