Open reduction and internal fixation versus external fixation and/or kirschner wires for distal radius fractures. A systematic review.

UNLABELLED: The aim of this study was to compare open reduction and plate fixation in the treatment of distal radius fractures with percutaneous fixation methods (external fixation and/or K-wires) regarding the outcome, using self-reported questionnaires (PRWE--Patient rated wrist evaluation, DASH--Disabilities of the Arm, Shoulder and Hand) as a primary aim, and grip strength and radiological parameters as a secondary aim.

DATA SOURCE: We performed a systematic review of available evidence through a search of the electronic Medline PubMed database.

STUDY SELECTION: Randomized clinical trials were included, as well as nonrandomized retrospective studies if they directly compared percutaneous fixation with ORIF, in the last ten years.

DATA EXTRACTION: Functional (PRWE, DASH), objective (grip strength), as well as radiographic outcomes were extracted and reported.

DATA SYNTHESIS: Ten studies were analysed, a total of 647 distal radius fractures (DRF) were included in the meta-analysis, 140 fractures treated with external fixation, 179 with K-wires (total 319 percutaneous fixation), and 328 fractures treated with ORIF. The meta-analysis showed no statistically significant differences between the results for the DRF treatment with ORIF or percutaneous methods at 3, 6 and 12 months regarding PRWE scores and grip strength, as well as final radiological outcome (volar tilt, radial length, radial tilt, ulnar variance). At 3 and 6 months there was a significant difference in the DASH score favouring open reduction and plate fixation, but at 12 months the meta-analysis showed no significant difference between the two methods compared.

CONCLUSIONS

The results of this meta-analysis for the operative treatment of distal radius fractures did not clearly demonstrate a relevant advantage of any of the fixation methods.