A Prospective Study Of Functional Outcome Following Intra-articular Fracture Of Distal Radius In Adults -- A Comparison Between External Fixation And Internal Plating

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A Prospective Study Of Functional Outcome
Following Intra-articular Fracture Of Distal
Radius In Adults -- A Comparison Between
External Fixation And Internal Plating

• Xu Weixin
• Lim Beng Hai
• Alphonsus Cheong
• Chloe Seow

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Introduction

• External fixation and internal plating are two
  common techniques used in the local hospitals for
  treatment of unstable distal radius fracture in
  the adults
• Most of the studies on results of surgical
  intervention reported encouraging results
  (Catalano et al. 1997 J Bone Joint Surg
  79A1290-302 Rikli et al 1996 J Bone Joint Surg
  78B588-92 Jakim et al. 1991 J Bone Joint Surg
  73B302-6)
• However, they were not done in a prospective,
  randomized manner

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Introduction

• Most of the randomized studies were comparing the
  results of casting with surgical treatments in a
  mixed-age population (Ludvigsen et al. Acta
  Orthop Scand 1997 68 225-258 Howard et al J
  Bone Joint Surg 1989 71B 68-73 Huchinson et al
  J Hand Surg 1995 20B 365-372 Stein et al Acta
  Orthop Scand 1990 61453-456)
• This study evaluated the external fixation and
  internal plating for the treatment of unstable
  distal radius fractures in a randomized
  prospective manner

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Aim of Study

• To compare the functional outcomes following
  external fixation and internal plating in the
  management of unstable intra-articular distal
  radius fractures, using both subjective and
  objective outcome measures.

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Methodology

• Inclusion criteria
• Age 16-60
• Patients with closed comminuted intra-articular
  fracture of the distal radius (AO classification
  of C2-C3) requiring surgical fixation
• Operation performed within three days post-injury

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Methodology

• Exclusion criteria
• Pathological fracture
• Old fracture on the same extremity
• Patients who are not likely to follow up to one
  year
• Complicated cases which requires to following
  different rehabilitation protocols (i.e. flap
  resurfacing, tendon repair/reconstruction and
  replantation done on the same injured extremity)

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Methodology

• Written consent was obtained from the patients
• The subjects were randomly allocated to the two
  different surgical treatment groups by the
  randomization envelop system
• The patients were referred to hand therapy 2 days
  after operation following standardized
  rehabilitation intervention

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Pre-op (case 1)
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Pre-op (case 2)
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Post-op (case 1)
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Post-op (Case 2)
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Methodology

• Demographic information

Ext Fix Int Plate
Number 17 (M14 F4) 22 (M18 F4)
Mean age 37.6 42.6
R hand dominance 17 (100) 22 (100)
R side injury 8 (47) 9 (41)
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Methodology

• Occupation

Ext Fix Int Plate
Sedentary 7 (41) 11 (50)
Manual 10 (59) 11 (50)
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Methodology

• Ethnic distribution (int. plating)
• Chinese 16 (72)
• Malay 2 (5)
• Indian 3 (14)
• Others 1 (5)

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Methodology

• Ethnic distribution (Ext. fixation)
• Chinese 13 (76)
• Malay 0 (0)
• Indian 3 (18)
• Others 1 (6)

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Methodology

• Functional evaluation
• outcomes were collected at 2 month, 3 month, 6
  month and 1 year post injury
• active range of motion of the wrist and forearm
• grip and pinch strength
• patient rated wrist evaluation (PRWE)
• modified Green and O'Brien scoring system.

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Methodology

• Standardized rehabilitation protocols were
  followed after both surgical interventions

Ext Fix Int Plate
0-4 weeks Finger AROM C-bar splint if necessary Interval wrist splint 2 weeks gentle wrist AROM
4-6 weeks Wrist splint for 2 weeks after R/O ext fixator gentle wrist AROM Continue wrist AROM PROM gentle strengthening
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Methodology
Ext Fix Int Plate
6-8 weeks Continue wrist AROM PROM Continue strengthening
8-12 weeks Start stretching Strengthening Work conditioning
12 weeks onwards Work conditioning
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Results

• Mean PRWE Score Over Time

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Results

• Mean Modified Green and O'Brien
• Score Over Time

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Results

• Pearson Chi-square test were used, and showed no
  significant differences between groups with
  regards to age, hand dominance, fracture side,
  cause of injury, occupation and associated
  injuries (Pgt.05)
• One-way ANOVA test were used to compare the
  functional outcomes between the two groups
  (Plt.05)
• Dorsi-flexion at 2-month post injury (P.029)
• Radiual deviation at 2-month post injury (P.002)
• Radiual deviation at 3-month post injury (P.001)
• No statically significant deference was detected
  from other variables

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Discussion

• Both internal plating and external fixation
  showed good functional results for treating
  unstable extra-articular distal radius fracture
• Internal plating provides earlier active
  rehabilitation and earlier return of certain
  range of motion of the wrist as compared with
  external fixation
• Further data analysis is need to look into
  radiographic characteristics and complications
  between these two groups

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Thank You!