External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

Abstract

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius (IFDR) in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after 1 week and 3, 6 and 12 months. After 3 months, the plating group had better pronation (P=0.001), supination, (P=0.047) and extension (P=0.043) scores. These differences were somewhat attenuated by 6 months and disappeared at 1 year. The plating group had a greater occurrence of wound infection (P=0.043), tendonitis, (P=0.024) and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the "gross motor" category (walking upstairs, bending over, walking 500 yards; P=0.023). Internal fixation was more advantageous than external fixation in the early rehabilitation period; after 1 year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

Figure 1

Radiographs of a 68-year-old man with a displaced intra-articular fracture of the distal radius that was treated by external fixation. (a and b) Anteroposterior and lateral radiograph before operation; (c and d) Anteroposterior and lateral radiograph during operation.

Figure 2

Radiographs of the distal radius with a comminuted intra-articular fracture after external fixation. (a and b) Anteroposterior and lateral radiographs after one month, (c and d) Anteroposterior and lateral radiographs after one year.

Figure 3

Radiographs of 73-year-old man with a comminuted intra-articular fracture of the distal radius that required treatment via Dorsal locked plating. (a and b) Anteroposterior and lateral radiographs before operation; (c and d) Anteroposterior and lateral radiographs during operation.

Figure 4

Radiographs of the man with a comminuted intra-articular fracture of the distal radius after treated by Dorsal locked plating. (a and b) Anteroposterior and lateral radiographs after one month, (c and d) Anteroposterior and lateral radiographs after one year.