Short term comparative study of external fixation versus volar locking compression plate in the treatment of unstable distal radius fractures

INTRODUCTION: Distal Radius fractures account for 14% of all extremity fractures, and 17% of all fractures treated in emergency department. As life expectancy increases, the incidence of distal radius fractures can be expected to increase as well. There appears to be a Bimodal distribution of distal radius fractures consisting of a younger group who sustains relatively high energy trauma to the upper extremity and an elderly group who sustains both high energy and low energy injuries. In older age groups, more women are affected than men. The majority of fracture in older population are due to fall, while in younger these fractures are due to motor vehicle accidents. Over past 20 years more sophisticated internal and External fixation technique, and devices have been developed. Specifically the use of percutaneous pin fixation, External fixation devices that permit distraction and palmar translation, Low profile internal fixation plates with locking screws, and arthroscopically assisted reduction have improved the management of distal radius fractures. AIM: This prospective study was to compare the clinical , functional and radiological outcome of two groups of patients treated by External fixation with supplementary ‘K’ wire fixation and by Volar locked plating for a Unstable distal radius fractures. MATERIALS AND METHODS: Prospective study of 20 cases of Distal Radius fractures at Government General Hospital from June 2008 to October 2009. Inclusion Creteria - Unstable Extra or Intra articular fractures of Distal Radius were included in this study. Cases were selected in random manner. In our study following cases were selected for external fixation : 1. Unstable extra articular fractures (Type I Fernandaz), 2. Compression- complex articular fractures( Type III Fernandaz) In Our study, following cases were selected for Volar plating: 1. Unstable extra articular fractures (Type I Fernandaz), 2. Shearing fractures (Type II Fernandaz), 3. Compression- complex articular fractures (TypeIII Fernandaz). Exclusion Creteria: Type IV & Type V Fernandaz types of Distal Radius Fractures. Compound injuries are excluded from the study. Elderly people and osteoporotic fractures were excluded. RESULTS: 1. Good radiological and clinical union is evidenced at 6-8 weeks although minimal dorsal tilt was seen in one case of external fixator group. 2. DASH score is higher in external fixator group than in volar plated group. In two volar plated group cases the score was higher because of fracture geomentry, improper reduction and poor compliance to physiotherapy. 3. Early improvement in range of movements in volar plated group. In the external fixator group patients had fair range of movements in initial period. But these patients gained reasonable range movements after intense physiotherapy. 4. No iatrogenic neuro vascular injury reported. 5. No post traumatic arthritis reported in our series. 6. Pin tract infection was reported in two cases. 7. Stiffness in shoulder was reported in one case of external fixator group because of poor compliance. 8. Grip strength was found to be better in volar plated group. CONCLUSION: External fixation or Internal fixation with volar locking plate yield better radiological and clinical outcome in unstable distal radius fracture in a short term follow up of 10 months. The movements in conventional External fixation improves with intense physiotherapy after period of 6-8 weeks (early immobilization period) in our cases. Use of locked volar plate predictably yields better patient reported outcome as per DASH score and allows earlier range of wrist motion which yields accelerated return of function