External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

Abstract

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius (IFDR) in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after 1 week and 3, 6 and 12 months. After 3 months, the plating group had better pronation (P=0.001), supination, (P=0.047) and extension (P=0.043) scores. These differences were somewhat attenuated by 6 months and disappeared at 1 year. The plating group had a greater occurrence of wound infection (P=0.043), tendonitis, (P=0.024) and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the “gross motor” category (walking upstairs, bending over, walking 500 yards; P=0.023). Internal fixation was more advantageous than external fixation in the early rehabilitation period; after 1 year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

Wrist fractures: To plate or not to plate?

Internal plating of wrist fractures in elderly patients results in more complications and no long-term benefit compared to external fixation. Wrist fractures involving the radius, a lower arm bone, are common, yet there has been little research on the best surgical treatment for elderly patients. To investigate, Li Cao and AihemaitijiangYusufu at The First Affiliated Hospital of Xinjiang Medical University in Urumqi, China, and colleagues randomized 123 wrist fracture patients to be treated with external fixation or internal plating and followed them up one week, 3, 6 and 12 months later. At 3 months, patients treated with plating had a better range of movement compared to the external fixation group, although these differences had reduced at 6 months and disappeared at 12 months. However, they experienced higher rates of wound infection, tendonitis and further surgery.

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