Comminuted Intra-Articular Fracture of the Distal Radius - The Technique of Open Reduction and Internal Fixation With Plating

Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study

BACKGROUND

The most effective method for the fixation of an intra-articular distal radial fracture has not been established. Two commonly used treatment methods are external fixation combined with percutaneous pin fixation and plate fixation. We performed a prospective multicenter randomized trial to compare these two treatment strategies.

METHODS

A total of 137 patients with 144 intra-articular distal radial fractures were recruited into the study. The average age of the patients was forty-two years, and all patients were sixty years old or less. The patients were randomized to fracture fixation with one of the two methods. At six, twelve, and twenty-four months postoperatively, the patients were assessed with use of the Gartland and Werley point system and the modified Green and O'Brien scoring system. Arthritis was graded on radiographs according to a modification of the Knirk and Jupiter criteria.

RESULTS

Seventy-four (51%) of the fractures were treated with external fixation and percutaneous pin fixation, and seventy were treated with dorsal, volar, or combined plate fixation. At the time of the twenty-four-month follow-up, the results for the plate fixation group were significantly better than those for the external fixation and percutaneous pin fixation group according to the Gartland and Werley point system (p = 0.04) and the radiographic arthritis grading system (p = 0.01). The difference was especially notable among patients with AO group-C2 fractures.

CONCLUSIONS

Plate fixation is better than external fixation combined with percutaneous pin fixation for the treatment of intra-articular fractures of the distal part of the radius.

Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate--a biomechanical study in a cadaveric model

The stability of palmar plate fixation using a locking compression T-plate was compared with that of a conventional palmar T-plate and a dorsal T-plate in a cadaveric model of an AO type C2 fracture of distal radius. The wrist axial load transmission through the radius was tested for each fixation. The results show that, under 100N axial load, the palmar locking compression T-plate restores stability comparable to that of the intact radius, and is superior to conventional palmar or dorsal T-plates.

A cadaveric model for biomechanical study of fixation methods for AO type C2 fractures of distal radius: design and testing with dorsal plating fixation

Fracture of the distal radius is a common injury. Functional recovery correlates well with restoration of anatomy and early motion. Various fixation methods have been proposed to achieve this. To evaluate the stability of different treatment options, a cadaveric model for biomechanical study of fixation methods for AO type C2 fracture of distal radius was designed and its efficacy assessed in the present experiment.