[Meta-analysis of external fixator and open reduction and internal fixation for the treatment of distal radius fracture]

Abstract

Objective: To compare clinical efficacy and safety of plate internal fixation (ORIF) and external fixator (EF) in treating distal radius fractures by Meta-analysis.

Methods: From establishment of database to August, 2019, randomized controlled trial (RCT) about open reduction and internal fixation (ORIF) and external fixation (EF) in treating distal radius fractures was conducted by using computer-based databases, including CNKI, VIP, Wanfang Data, Medline, Cochrane library databases. Data extraction and quality evaluation of included study according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform Meta-analysis. Palm angle, ulnar deflection angle, radius height, grip strength, ulnar variation, disabilities of arm, shoulder and hand (DASH) score, total complication rate, infection rate and tendon rupture between two groups were compared.

Results: Totally 19 RCT were included with 1 730 patients, 873 patients in ORIF group and 857 patients in EF group. Meta analysis result showed that after operation at 12 months, there were no significant difference in radial height [MD=0.04, 95%CI (-0.90, 0.99), P=0.93], tendon rupture [RR=1.82, 95%CI (0.71, 4.67), P=0.21], carpal tunnel syndrome [RR=2.15, 95%CI(0.98, 4.70), P=0.06], complex regional pain syndrom [RR=0.63, 95%CI(0.31, 1.27)P=0.78] between two groups. While there were significant difference in palm inclination angle [MD=1.38, 95%CI (0.83, 1.93), P< 0.000 01], ulnar deflection angle[MD=0.99, 95%CI(0.54, 1.45), P<0.000 1], ulna variability[MD=0.66, 95%CI(0.21, 1.12), P=0.005], DASH score[MD=2.42, 95%CI(0.37, 4.46), P=0.02], incidence of complications[RR=0.83, 95%CI(0.71, 0.96), P=0.01], infection rate[RR=0.20, 95%CI(0.11, 0.36), P<0.000 1]between two groups. There was statistical difference in tendinitis incidence between two groups [MD=3.88, 95%CI (1.56, 9.64), P<0.003].

Conclusion: Compared with EF in treating distal radius fracture, ORIF has better clinical effects in postoperative complications, palm angle, ulnar deviation angle, ulnar variation rate and infection rate. While there were no significant difference between in DASH score, radial height, tendon rupture and carpal tunnel syndrome better EF and ORIF. For the patient pursue rapid recovery of function, ORIF is better choice.

Keywords: External fixators; Fracture fixation, internal; Meta-analysis; Radius fractures.