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Comparison of External and Percutaneous Pin Fixation with Plate Fixation for Intra-articular Distal Radial Fractures

A Randomized Study

¹ Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Pokfulam, Hong Kong. E-mail address for F. Leung: klleunga{at}hkucc.hku.hk. E-mail address for S.-P. Chow: spchow{at}hkucc.hku.hk
² E-Da Hospital, 1 E-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, Kaohsiung County, Taiwan, 824, Republic of China. E-mail address: ed100130{at}edah.org.tw
³ Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. E-mail address: Winston_Chew_YC{at}ttsh.com.sg

Investigation performed at Queen Mary Hospital, Pokfulam, Hong Kong, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore, and Chang Gung Memorial Hospital, Keelung, Taiwan

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the AO Research Institute. Neither they nor a member of their immediate families received 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, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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