J Korean Fract Soc.  2010 Jan;23(1):76-82. 10.12671/jkfs.2010.23.1.76.

Treatment for Unstable Distal Radius Fracture with Osteoporosis: Internal Fixation versus External Fixation

• Oh JR
• Cho TY
• Kwan SM

• KMID: 1461576
• DOI: http://doi.org/10.12671/jkfs.2010.23.1.76

Abstract

PURPOSE
To compare the functional and radiological outcomes of volar plating to that of external fixation for treating unstable osteoporotic distal radius fracture.
MATERIALS AND METHODS
From March 2006 to March 2008, 36 patients with osteoporosis over 60-year old were selected for this study. They were divided into two groups; group I (open reduction and internal fixation with volar fixed angle plate) and group II (closed reduction and external fixation). Clinical outcomes and radiologic outcomes were evaluated.
RESULTS
There was no statistical difference between group I and group II in range of motion and DASH score, BMD score. However, the grip strength and PRWE score were found to be higher in group II (p<0.05). In radiologic evaluation, group I showed higher radial inclination, volar tilting angle (p<0.05).
CONCLUSION
Internal fixation using Volar-fixed Angle Plate seems to give more stable fixation for distal articular fragments compared to external fixation. it could allow early postoperative exercise and could result in low incidence of postoperative complication such as pin track infections and joint stiffness. Therefore, the internal fixation could be more desirable treatment method to manage unstable distal radius fracture.

Keyword

Distal radius; Unstable fracture; Osteoporosis; Internal fixation; External fixation

MeSH Terms

Hand Strength
Humans
Incidence
Joints
Osteoporosis
Postoperative Complications
Radius
Radius Fractures
Range of Motion, Articular
Track and Field

Figure

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  Fig. 1 Acu-loc® volar fixed angle plate

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  Fig. 2 67-year-old woman with unstable distal radius fracture was treated by OR & IF with Acu-loc® volar fixed angle plate (BMD: -3.5). (A) Preoperative radiographs show AO classification C2. (B) Immediate postoperative radiographs show reduction and fixation. (C) Radiographs at 13 months postoperatively show no significant change.

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  Fig. 3 Penning Orthofix® external fixator.

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  Fig. 4 65-years-old woman with unstable distal radius fracture was treated by CR pinning & EF with Penning Orthofix® external fixation and MIIG® injection (BMD: -5.2). (A) Preoperative radiographs and CT shows AO classification C3. In CT, there was severe comminution and joint depression, the fracture lines in tidal mark of distal radius. Therefore, it was not available internal fixation. (B) Immediate postoperative radiographs shows closed reduction and percutaneous pinning with K-wires with external fixator and MIIG® injection. (C) Postoperative radiographs at 6 months shows bony union and restroring joint congruity.

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  Fig. 5 Postop active ROM exercise after CR pinning & EF with Penning Orthofix® external fixation (BMD: -2.7).

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