Treatment Outcomes of Applying External Fixator on Distal Radius Fractures: A Randomized Clinical Trial to Compare between Two Directions of Force Exertion in Parallel to Radius Shaft and Perpendicular to the Distal Radius Articular Surface

Abstract

Background: External fixation has been one of the conventional managements of unstable distal radius fracture. The main aim of this paper is to compare two methods of applying distractive force along the radius shaft versus perpendicular to the distal radius articular surface.Design: Sixty patients with unstable distal radius fracture were included in present clinical trial and randomized in two groups, using block randomization method. In group A (first arm), distraction force was exerted parallel to the radius shaft. In group B (second arm), the external fixator was adjusted based on radial and palmar tilt of the mean population healthy wrist so that distraction was exerted perpendicular to the wrist articular surface.Methods: Radiological and clinical parameters were evaluated in both groups of patients pre-operatively, immediately after surgery, and 6 weeks post-operatively. We also followed up patients clinically at 12 weeks after surgery. PRWE, Mayo, and DASH questionnaires were used in order to assess patients’ clinical and functional states.Results: The method used in group B resulted in better improvement of palmar tilt both immediately (P = 0.007) and at 6 weeks follow up (P = 0.013) post-operatively in comparison with patients in group A. Radius height and radial inclination were also better restored when using the proposed modified method (P = 0.001 and <0.001, respectively). Clinical outcomes were not different between two groups. Conclusion: Applying distractive force perpendicular to the distal radius articular surface seems to improve some radiological outcomes, probably due to better reduction maintenance, when compared with the technique of applying distraction force along distal radius shaft axis.Level of Evidence: Level I (clinical trial study)

What’s New in Orthopaedic Trauma

“…Although the surgical standard of care for distal radial fractures is volar plating, there are circumstances in which application of an external fixator may be advantageous, such as gross contamination or soft-tissue loss. An RCT evaluated the impact of the direction of force exertion with an external fixator on radiographic and clinical outcomes of distal radial fractures 10 . Specifically, they compared distractive forces parallel to the radial shaft and perpendicular to the articular surface.…”

Clinical application of instant 3D printed cast versus polymer orthosis in the treatment of colles fracture: a randomized controlled trial

“…The technique has changed little since it was invented in the 10th century. The shortcomings of plaster, such as water resistance, air permeability, skin comfort, fixed stability and weight of cast wear are still to be solved [3]. Recently polymer orthosis has replaced traditional plaster for the immobilization of fractured limbs and become the most commonly used external fixation material for fractures treatment in Chinese hospitals [4].…”