A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures.

Distal radius fractures are common injuries in older adult patients. The present prospective study aimed to compare the efficacies of bridging external fixation (BEF) and combined external fixation (CEF) in preventing radial height loss in older patients with distal radius fractures. Between January 2018 and December 2022, a total of 118 patients with distal radius fractures, aged 55-70 years, were randomly subjected to either BEF or CEF. Standard radiographs were used to measure radiological parameters, including radial height, palmar tilt, radial inclination, ulnar variance, articular step-off and Lidström classification. All patients were examined for active range of motion, grip strength, supination torque, level of pain during specified activities with a numeric rating scale, modified Mayo Wrist Score, Disabilities of the Arm Shoulder and Hand score, Patient-Rated Wrist Evaluation score and patient satisfaction. The patient characteristics showed significant differences in terms of operative time (t=12.52; P<0.01), successful closed reduction (χ2=32.74; P<0.01), change to open surgery (χ2=32.74; P<0.01) and cost (t=4,585.26; P<0.01). The t-tests showed significant differences (P<0.01) in the radiological parameters of intraoperative closed reduction between the two groups. By contrast, no significant differences (P>0.05) were observed in the radiological parameters between bone healing and final follow-up within each group, and in the radiological parameters of bone healing and final follow-up between the two groups. Lidström classification showed significant differences between bone healing and final follow-up within the BEF group (χ2=5.96; P<0.05) and the CEF group (χ2=8.18; P<0.01), but no significant differences at the time of bone healing (χ2=3.57; P=0.06) and final follow-up (P=0.12) between the two groups. Furthermore, the t-tests showed no significant differences (P>0.05) in the functional and clinical outcomes between the two groups at the final follow-up. In conclusion, CEF may be as effective as BEF in preventing radial height loss in older patients with distal radius fractures. Percutaneous bony distraction may be more effective than conventional distraction manoeuvres in achieving anatomical reduction with minor morbidity. The two techniques demonstrate a similar ability for bone remodeling. Further studies on the therapeutic advantages of CEF over BEF are warranted, especially considering its lower cost compared with BEF.