Prospective Randomized Study Comparing the External Fixator and Volar Locking Plate in Intraarticular Distal Radius Fractures: Which Is Better?

Abstract

Introduction Various treatment options for patients with an intraarticular distal radius fracture are available, but in cases of comminuted fractures, these narrow down to either a volar locking plate, an external fixator, or a combination of these two. We conducted this prospective study to compare the external fixation and internal fixation of intraarticular fractures of the distal radius in terms of clinical/functional outcome and complications and with the available literature. Material and method This prospective randomized study consisted of a total number of 30 patients with intraarticular fractures of the distal end of the radius divided randomly into two groups (A and B), treated by external fixation (Group A) and volar plating (Group B), in a tertiary care institute during the study period. Result The most patients were males >50 years of age, with injury to the right dominant hand most commonly caused by a fall on an outstretched hand. As per the modified Green & O'Brien scoring system, the volar plating group showed the final result as excellent in two (13.33%), good in seven (46.6%), fair in four (26.6%), and poor in two (13.3%) whereas an excellent outcome was seen in one (6.66%), good and fair in five patients each (33.3%), and poor in four (26.66%) patients at the six months follow-up. Conclusion Overall, both fixation techniques seem to apply sufficient stabilization to restore function and retain anatomy; however, volar locking plates have certain advantages over external fixator in the early postop period in terms of earlier recovery and mobilization.

Keywords: external fixator; intraarticular fracture distal radius; modified green & o’brien score; volar plating.

Figure 1. A: Preoperative radiograph showing intraarticular distal radius fracture (AO type C3); B: Postoperative radiograph with external fixator in situ; C: Six-month follow-up radiograph showing radiological union

Figure 2. A: Preoperative radiograph showing intraarticular distal radius and ulnar styloid fracture; B: Postoperative radiograph with the volar locking plate and DRUJ K wire in situ; C: Six-month follow-up radiograph showing radiological union

DRUJ: Distal radioulnar joint; K wire: Kirschner wires

Figure 3. Graph showing modified Green & O’Brien scores at different follow-ups

Statistical significance is seen at three months although no difference is noted at the six-month follow-up. § Mean statistical significance (p=0.016)