Bridging external fixation versus non-bridging external fixation for unstable distal radius fractures: A systematic review and meta-analysis

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

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Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis

Strategies in Trauma and Limb Reconstruction ◽

10.1007/s11751-013-0169-4 ◽

2013 ◽

Vol 8 (2) ◽

pp. 67-75 ◽

Cited By ~ 31

Author(s):

J. C. Goslings ◽

Monique M. J. Walenkamp ◽

Abdelali Bentohami ◽

M. Suzan H. Beerekamp ◽

Rolf W. Peters ◽

...

Keyword(s):

Functional Outcome ◽

External Fixation ◽

Distal Radius ◽

Locking Plate ◽

Meta Analysis ◽

Distal Radius Fractures ◽

Plate Versus ◽

Volar Locking Plate ◽

Radius Fractures

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Dynamic versus static external fixation for unstable distal radius fractures: An up-to-date meta-analysis

Yearbook of Hand and Upper Limb Surgery ◽

10.1016/j.yhls.2013.02.026 ◽

2013 ◽

Author(s):

R. Grewal

Keyword(s):

External Fixation ◽

Distal Radius ◽

Meta Analysis ◽

Distal Radius Fractures ◽

Radius Fractures

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Complications of Distal Radius Fractures in the Elderly: A Systematic Review and Meta-analysis

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2017.06.029 ◽

2017 ◽

Vol 42 (9) ◽

pp. S8 ◽

Cited By ~ 1

Author(s):

Paul Kooner ◽

Rajeshwar S. Sidhu ◽

Joy MacDermid ◽

Ruby Grewal

Keyword(s):

Systematic Review ◽

Distal Radius ◽

Meta Analysis ◽

The Elderly ◽

Distal Radius Fractures ◽

Radius Fractures

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Complications following open reduction and internal fixation versus external fixation in treating unstable distal radius fractures: Grading the evidence through a meta-analysis

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2017.08.020 ◽

2018 ◽

Vol 104 (1) ◽

pp. 95-103 ◽

Cited By ~ 11

Author(s):

Z.Z. Yuan ◽

Z. Yang ◽

Q. Liu ◽

Y.M. Liu

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Distal Radius ◽

Open Reduction ◽

Meta Analysis ◽

Distal Radius Fractures ◽

Radius Fractures

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Dorsal Bridge Plating versus External Fixation for Distal Radius Fractures

Journal of Wrist Surgery ◽

10.1055/s-0039-1694063 ◽

2019 ◽

Vol 09 (02) ◽

pp. 177-184

Author(s):

William L. Wang ◽

Asif M. Ilyas

Keyword(s):

External Fixation ◽

Distal Radius ◽

Meta Analysis ◽

Pain Syndrome ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Hardware Failure ◽

Pubmed Database ◽

Significant Difference ◽

Bridge Plating

Abstract Background External fixation and dorsal bridge plating are wrist spanning fixation options for distal radius fractures; however, their comparative effectiveness is not well understood. A meta-analysis was conducted to compare the clinical outcomes between these two techniques. Materials and Methods A PubMed database query of all distal radius fracture cases managed with spanning external fixation or dorsal bridge plating was performed. A total of 28 articles met inclusion criteria, yielding 895 patients for data extraction and comparative analysis. Results Dorsal bridge plating demonstrated lower rates of infection (2 vs. 10%, p = 0.05) and complex regional pain syndrome (1 vs. 4%, p = 0.04) but higher rates of hardware failure (4 vs. 1%, p = 0.026). Bridge plating also demonstrated higher rates of excellent/good ratings under the Gartland and Werley outcome score (91 vs. 83%, p = 0.016). There was no significant difference in DASH (Disability of the Arm, Shoulder, and Wrist) scores, radiographic parameters, or unplanned reoperations between the two spanning fixation options. Conclusion Bridge plating and external fixation both appear to be comparable for spanning fixation constructs for distal radius fractures, but with bridge plating having a potentially lower complication profile.

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