External versus internal fixation of intra-articular distal radius fractures: a randomised controlled trial.

Background: Aim of the randomised controlled trial was to compare the long-term outcomes following external fixation with wrist distractor and Kirschner wires (EF) with those after internal fixation with volar locking plates (IF) of displaced, intra-articular distal radius fractures in patients 18 to 65 years of age.

Methods: Surgery was performed after taking informed written consent following inclusion and randomisation. The primary outcomes were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and Jakim's score, and secondary outcomes included wrist range of motion, grip strength and pain. Linear mixed models were employed to assess and compare the 2 groups.

Results: The patients in both groups had comparable mean Quick DASH and Jakim's score, range of motion, and grip strength with no significant differences between the groups at all follow-ups. The overall complication rate was equivalent between the 2 groups, although, the rate of reoperations was higher in the IF group (p=0.03). Implant prominence or impingement was responsible for the IF group result values falling short of normal limb values even on long-term follow-up. While, results of EF group homogenously and successfully achieved normal limb functionality. At 3 years the rate of follow-up was 97%.

Conclusions: Biological healing through EF offers more natural anatomical restoration of the distal radius as evident by better long-term scores and statistically significant low reoperations rate. Absence of long-term bone-implant contact in EF group is identified as the sole factor promoting complete functional and clinical recovery.

Level of evidence: Therapeutic Level I.