Comparison of External Fixation and Supplementary Kirschner-Wires Fixation With Volar Locking Plate for the Treatment of Intra- Articular Distal End Radius Fractures

  • Rajeev Dwivedi Lumbini Medical College and Teaching Hospital https://orcid.org/0000-0001-7734-3931
  • Mandir Khatri Lumbini Medical College and Teaching Hospital
  • Arjun KC Lumbini Medical College and Teaching Hospital
Keywords: External fixation, Functional outcomes, Green and O’Brien score, Intra-articular distal radius fracture, Volar locking plate

Abstract

 Introduction: There are controversies regarding the benefit of open reduction and internal fixation with volar locking plates over closed reduction and external fixation along with supplementary Kirschner wires fixation for intra-articular distal end radius fracture. Therefore, this study aimed to compare the outcomes between external fixation along with supplementary Kirschner wires with volar locking plate in the treatment of intra-articular distal end radius fractures. Methods: This prospective, observational and analytical study was conducted over one and a half years. Forty-seven adults with displaced intra-articular distal end radius fracture were included in the study. Twenty-one cases were treated with closed reduction and external fixation along with supplementary Kirschner wires, whereas 26 patients were treated with open reduction and volar locking plate fixation. Results: At the end of three months, as per the Green and O’Brien scoring, the mean functional outcome score in the volar plate group was significantly better 80.77(±11.46) than the external fixation group 70.24(±10.66) (p=0.002). However, at the end of six months, the mean score in the volar plate group 86.15(±7.39) was not significantly different from the external fixation group 81.43(±9.63) (p= 0.63). Fracture reduction was achieved and maintained better in the volar locking plate group. Conclusion: Functional outcome of closed reduction and external fixation along with supplementary Kirschner wires is comparable with open reduction and internal fixation by volar locking plate in treatment of displaced intra-articular distal radius fractures. Radiological correction is achieved and maintained better with volar locking plates.

Downloads

Download data is not yet available.

Author Biographies

Rajeev Dwivedi, Lumbini Medical College and Teaching Hospital

Associate Professor,

Department of Orthopedics.

Mandir Khatri, Lumbini Medical College and Teaching Hospital

Lecturer,

Department of Orthopedics.

Arjun KC, Lumbini Medical College and Teaching Hospital

Resident,

Department of Orthopedics.

References

Koval K, Haidukewych GJ, Service B, Zirgibel BJ. Controversies in the management of distal radius fractures. J Am Acad Orthop Surg. 2014;22(9):566-75. PMID: 25157038. DOI: https://doi.org/10.5435/jaaos-22-09-566

Schneppendahl J, Windolf J, Kaufmann RA. Distal Radius Fractures: Current Concepts. J Hand Surg. 2012;37(8):1718-25. PMID: 22763062. DOI: https://doi.org/10.1016/j.jhsa.2012.06.001

Shin EK, Jupiter JB. Current Concepts in the Management of Distal Radius Fractures. 2007;74(4):233-46. PMID: 17877939

Handoll HHG, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;(3):CD003209. PMID: 12917953. DOI: https://doi.org/10.1002/14651858.cd003209

Pradhan RL, Sharma S, Pandey BK, Manandhar RR, Prasai T, Lakhey S, et al. Comparison of volar locking plate and external fixation with K wire augmentation in unstable distal radius fractures. Nepal Medical College Journal. 2015;17(1– 2):67-72. Available from: https://www.nmcth.edu/images/gallery/Vol.%2017%20No.%201-2%20March/June%202015/pradhan_rl.pdf

Shukla R, Jain RK, Sharma NK, Kumar R. External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes. J Orthop Traumatol. 2014;15(4):265-70. PMID: 25193416. DOI: https://doi.org/10.1007/s10195-014-0317-8

Kwok IHY, Leung F, Yuen G. Assessing Results After Distal Radius Fracture Treatment: A comparison of Objective and Subjective Tools. Geriatr Orthop Surg Rehabil. 2011;2(4):155- 60. PMID: 23569685. DOI: https://doi.org/10.1177/2151458511422701

Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury. 2002;33(6):499- 502. PMID: 12098546. DOI: https://doi.org/10.1016/s0020-1383(01)00174-7

Dario P, Matteo G, Carolina C, Marco G, Cristina D, Daniele F, et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury. 2014;45(Suppl 6):S21-6. PMID: 25457314. DOI: https://doi.org/10.1016/j.injury.2014.10.018

Slutsky DJ. External fixation of distal radius fractures. J Hand Surg. 2007;32(10):1624- 37. PMID: 18070654. DOI: https://doi.org/10.1016/j.jhsa.2007.09.009

Paksima N, Panchal A, Posner MA, Green SM, Mehiman CT, Hiebert R. A meta-analysis of the literature on distal radius fractures: review of 615 articles. Bull Hosp Jt Dis. 2004;62(1-2):40-6. PMID: 15517856.

Wilcke MKT, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop. 2013;84(3):292-6. PMID: 23594225. DOI: https://doi.org/10.3109/17453674.2013.792035

Downing ND, Karantana A. A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br. 2008;90-B(10):1271- 5. PMID: 18827233. DOI: https://doi.org/10.1302/0301-620x.90b10.21293

Jagdev SS, Kedia R, Pathak SK, Salunke A. Comparison of outcome of extra articular lower end radius fracture with percutaneous pinning and volar locking plate. International Journal of Research in Orthopaedics. 2017;3(4):651-5. DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20172503

Sharma A, Pathak S, Sandhu H, Bagtharia P, Kumar N, Bajwa RS, et al. Prospective Randomized Study Comparing the External Fixator and Volar Locking Plate in Intraarticular Distal Radius Fractures: Which Is Better? Cureus. 2020;12(2):e6849. PMID: 32181084. DOI: https://doi.org/10.7759/cureus.6849

Xu GG, Chan SP, Puhaindran ME, Chew WY. Prospective Randomised Study of Intra-Articular Fractures of the Distal Radius: Comparison Between External Fixation and Plate Fixation. 2009;38(7):600-6. PMID: 19652851

Jeudy J, Steiger V, Boyer P, Cronier P, Bizot P, Massin P. Treatment of complex fractures of the distal radius: A prospective randomised comparison of external fixation ‘versus’ locked volar plating. Injury. 2012;43(2):174-9. PMID: 21704995. DOI: https://doi.org/10.1016/j.injury.2011.05.021

Wang J, Lu Y, Cui Y, Wei X, Sun J. Is volar locking plate superior to external fixation for distal radius fractures? A comprehensive meta-analysis. Acta Orthop Traumatol Turc. 2018;52(5):334-42. PMID: 30497657. DOI: https://doi.org/10.1016/j.aott.2018.06.001

Fu Q, Zhu L, Yang P, Chen A. Volar Locking Plate versus External Fixation for Distal Radius Fractures: A Meta-analysis of Randomized Controlled Trials. Indian J Orthop. 2018;52(6):602-10. PMID: 30532300. DOI: https://doi.org/10.4081/or.2019.7809

Gouk C, Ng SK, Knight M, Bindra R, Thomas M. Long term outcomes of open reduction internal fixation versus external fixation of distal radius fractures: A meta-analysis. Orthop Rev (Pavia). 2019;11(3):7809. PMID: 31579208. DOI: https://doi.org/10.4081/or.2019.7809

Kasapinova K, Kamiloski V. Outcome evaluation in patients with distal radius fracture. Prilozi. 2011;32(2):231-46. PMID: 22286627

Published
2020-10-21
How to Cite
1.
Dwivedi R, Khatri M, KC A. Comparison of External Fixation and Supplementary Kirschner-Wires Fixation With Volar Locking Plate for the Treatment of Intra- Articular Distal End Radius Fractures. J Lumbini Med Coll [Internet]. 21Oct.2020 [cited 3Dec.2020];8(2):6 pages. Available from: https://jlmc.edu.np/index.php/JLMC/article/view/397
Section
Original Research Article