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The Journal of Bone and Joint Surgery (American) 85:660-666 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

External Fixation of Distal Radial Fractures: Four Compared with Five Pins

A Randomized Prospective Study

K.-D. Werber, MD, F. Raeder, MD, R. B. Brauer, MD and S. Weiss, MD

Investigation performed at Klinikum rechts der Isar, Technische Universität München, Munich, Germany

K.-D. Werber, MD
F. Raeder, MD
R.B. Brauer, MD
Chirurgische Klinik und Poliklinik (K.-D.W. and R.B.B.), Klinik für Orthopädie (F.R.), Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany. E-mail address for K.-D. Werber: werber{at}nt1.chir.med.tu-muenchen.de

S. Weiss, MD
Stiftung Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Read in part at the Annual Meeting of the American Society for Surgery of the Hand, Boston, Massachusetts, September 4, 1999.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: The purpose of this study of distal radial fractures was to compare the radiographic and clinical results after use of a standard four-pin external fixator with those after use of a five-pin fixator with the fifth pin stabilizing the distal radial articular fragment.

Methods: In an open prospective trial, fifty patients with an unstable distal radial fracture were randomized for treatment with closed reduction and either a standard small Association for the Study of Internal Fixation (ASIF) four-pin fixator (twenty-five patients) or a five-pin external fixator (twenty-five patients). The fixators were removed at nine weeks, and all patients were assessed radiographically and clinically at six months.

Results: Follow-up radiographs demonstrated significantly less loss of alignment and length with the five-pin external fixator. Pin site infections were more prevalent with the four-pin fixator. The range of motion of the wrist and forearm, the grip strength, and the Lidstrom functional ratings at six months were all significantly better after use of the five-pin fixator.

Conclusions: The use of a five-pin external fixator, with the fifth pin stabilizing the distal radial articular fragment, yields better radiographic and functional results than does a four-pin fixator.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.


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External fixation for distal radial fractures-Role of the TFCC
Vikas Yadav, et al.
JBJS Online, 30 Jun 2003 [Full text]