Functional Outcomes for Unstable Distal Radial Fractures Treated with Open Reduction and Internal Fixation or Closed Reduction and Percutaneous Fixation: A Prospective Randomized Trial

Rozental, Tamara D.; Blazar, Philip E.; Franko, Orrin I.; Chacko, Aron T.; Earp, Brandon E.; Day, Charles S.
August 2009
Journal of Bone & Joint Surgery, American Volume;Aug2009, Vol. 91-A Issue 8, p1837
Academic Journal
Background: Despite the recent trend toward internal fixation of distal radial fractures, few randomized trials have examined whether volar plate fixation is superior to other stabilization techniques. The purpose of the present study was to compare (1) open reduction and internal fixation with use of a volar plate and early mobilization with (2) percutaneous fixation and casting or external fixation for the treatment of dorsally displaced unstable extra-articular and simple intra-articular fractures of the distal part of the radius, with a specific emphasis on early functional recovery. Methods: A prospective randomized study was performed at two institutions. Forty-five consecutive patients with a displaced, unstable fracture of the distal part of the radius were randomized to closed reduction and pin fixation (n = 22) or open reduction and internal fixation with a volar plate (n = 23). Clinical and radiographic assessments were conducted at six, nine, and twelve weeks after surgery and at one year. Outcome was measured on the basis of range of motion; grip and pinch strength; and Disabilities of the Arm, Shoulder and Hand scores. A questionnaire was used to determine patient satisfaction, and a detailed analysis of complications was performed. Results: Patients in the open reduction and internal fixation group had superior Disabilities of the Arm, Shoulder and Hand scores at six, nine, and twelve weeks. At six weeks, the average Disabilities of the Arm, Shoulder and Hand score was 27 in the open reduction and internal fixation group as compared with 53 in the closed reduction and pin fixation group (p < 0.01). At nine and twelve weeks, patients in the open reduction and internal fixation group continued to have lower scores (17 compared with 39 [p < 0.01] and 11 compared with 26 [p = 0.01], respectively). At one year, there was no significant difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand scores. Patients in the open reduction and internal fixation group had greater range of motion and strength than patients in the closed reduction and pin fixation group at six and nine weeks, and more patients in the open reduction and internal fixation group were very satisfied with the overall wrist function and motion. Eight complications occurred, two in the open reduction and internal fixation group and six in the closed reduction and pin fixation group. Conclusions: Both closed reduction with percutaneous pin fixation and open reduction with internal fixation with use of a volar plate are effective methods for the treatment of dorsally displaced, unstable, extra-articular or simple intra- articular fractures of the distal part of the radius. Better functional results can be expected in the early postoperative period in association with open reduction and internal fixation, and this form of treatment should be considered for patients requiring a faster return to function after the injury. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • ESIN in Forearm Fractures. Lieber, Justus; Joeris, Alexander; Knorr, Peter; Schalamon, Johannes; Schmittenbecher, Peter P. // European Journal of Trauma;Feb2005, Vol. 31 Issue 1, p3 

    Background and Purpose: Elastic stable intramedullary nailing (ESIN) is well established for stabilizing pediatric forearm fractures. To prevent uncritical use, it is necessary to evaluate the problems and complications of this common technique. Patients and Methods: Four pediatric surgical...

  • A Novel Implant Regarding Transcondylar Humeral Fractures Stabilization. A Comparative Study of Two Approaches. Eduard, Mitroi; Daniel, Vlasceanu; Titi, Bajenescu; Horia-Alexandru, Petrescu // Annals of DAAAM & Proceedings;2013, Vol. 24 Issue 1, p1201 

    The osteosynthesis of transcondylar humeral fractures is an important branch of the upper limb traumatology. The boneimplant assembly has to be strong enough to resist the high loads arising during the early rehabilitation program, while keeping the soft tissue stripping to a minimum. Using the...

  • Classic adolescent injury mimics a twisted ankle. Rizzolo, Denise; Min, William // JAAPA: Journal of the American Academy of Physician Assistants (;Jan2010, Vol. 23 Issue 1, p57 

    The article presents a case study of a 12-year-old boy who was sent to the school clinic for a twisted ankle injury. He underwent ankle radiograph which showed a transitional fracture, involving forceful external rotation of the ankle occurring during a fall. A discussion of saggital fracture,...

  • Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia. McCann, Philip A.; Jackson, Mark; Mitchell, Steve T.; Atkins, Roger M. // International Orthopaedics;Mar2011, Vol. 35 Issue 3, p413 

    series of 49 pilon fractures in a tertiary referral centre treated definitively by open reduction and internal fixation have been assessed and the complications of such injuries examined. A retrospective analysis of case notes, radiographs and computerised tomographs over a seven-year period...

  • Clinical evaluation of patients with distal end of the radius fracture treated with percutaneous ixation. Elizondo-Elizondo, H.; Cárdenas-Estrada, E.; Mendoza-Mendoza, J. G.; Vilchez-Cavazos, F.; Mendoza-Lemus, O. F.; Acosta-Olivo, C. A. // Acta Ortopedica Mexicana;sep/oct2010, Vol. 24 Issue 5, p311 

    No abstract available.

  • Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures. Geller, Loren; Bernstein, Mitchell; Carli, Alberto; Berry, Greg; Reindl, Rudy; Harvey, Edward // Canadian Journal of Surgery;Oct2009, Vol. 52 Issue 5, pE161 

    Background: Fracture of the distal radius is a common injury. Many treatment options exist for the surgical management of extra-articular and intra-articular distal radius fractures. The best method of treatment for these fractures remains controversial. We sought to examine radiographic...

  • Proposta de novo modelo de osteossíntese em fêmur: pinos intramedulares múltiplos bloqueados. Izquierdo Caquías, Daniela Fabiana; Semiglia Repetto, Gabriel Gastón; Roston, Enrique Cueto; Auada Ferrigno, Cássio Ricardo; da Cunha, Olicies // Acta Scientiae Veterinariae;Sep2011, Vol. 39 Issue 3, Special section p1 

    Background: Currently many methods of internal fixation for the treatment of fractures in dogs are used. Attempting bone fixation with intramedullary nails is a traditional concept, making it a simple and versatile technique. However, biomechanical faults are frequent, and rotational...

  • "Prospective study of management of unstable distal radius fracture with volar plate osteosynthesis.". Shetty, Abhishek V.; Atmananda, S.; Hegdg, Deepak K. Raj; Mahesha, K. // International Journal of Biological & Medical Research;2014, Vol. 5 Issue 3, p4300 

    Introduction: - Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction and stabilization. Displaced...

  • Two Procedures for Kirschner Wire Osteosynthesis of Distal Radial Fractures. Strohm, P. C.; Müller, C. A.; Boll, T.; Pfister, U. // Journal of Bone & Joint Surgery, American Volume;Dec2004, Vol. 86-A Issue 12, p2621 

    Background: The treatment of displaced Colles-type fractures of the distal part of the radius remains a challenge. Two procedures for closed reduction and Kirschner wire osteosynthesis of these fractures were compared in a prospective randomized study. Methods: One hundred consecutive patients...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics