Comparative study on the analysis of functional outcome in distal radius articular fractures treated by closed reduction through bridging external fixator augmented with K-wires and Volar-locking plating

PURPOSE: The purpose of this study was to compare the functional outcome in distal radius articular fractures treated by closed reduction through bridging external fixator augmented with k-wires and volar-locking plating. METHODS: This study included patients with comminuted unstable intra-articular distal radius fractures treated at Rajiv Gandhi Govt. General Hospital. 27 patients treated with either modality of treatment were analysed, who had been followed up for an average of was 8.9 months, ( range : 3 months to 24 months). Prospective and retrospective data were gathered on patients, of which 15 were treated with external fixator augmented with k-wire and 12 were treated with 2- column fixed- angle volar LCP . The 2 groups were compared for range of motion (ROM), strength, and functional outcome as measured by the Mayo wrist score. Fracture reduction was evaluated from radiographs taken at the last follow-up visit and compared between groups. Sarmiento’s modification of Lindstorm’s criteria was used to compare the radiological outcome in both the groups. RESULTS: The mean passive wrist ROM at the final follow-up evaluation in ext fixation patients was 55 degrees extension and 67 degrees flexion, compared with 69 degrees extension and 77 degrees flexion in patients treated with volar LCP group. Whereas mean passive wrist ROM at the final follow-up evaluation in ext fixation patients was 58 degrees supination and 46 degrees pronation, compared with 76 degrees supination and 64 degrees pronation in patients treated with volar LCP group. Final radiographic measurements for the Ext fixation group averaged 2.9 degrees volar tilt and 14.2 mm degrees radial inclination, with 5mm radial length. The Volar LCP group averaged 7.3 degrees volar tilt, 16.9 degrees radial inclination, with 9.75mm radial length. Radial length and volar tilt were significantly greater for the ORIF group when compared with the radial length. There was significant difference in the radiological and functional outcome of AO Muller type C fractures treated by volar LCP with respect to the external fixator group ( p value 0.009 and 0.026 respectively ). There was no significant difference in the radiological and functional outcome of AO Muller type B fractures treated by volar LCP with respect to the external fixator group ( p value 0.706 and 0.707 respectively ). CONCLUSION: The use of ORIF with a volar fixed-angle implant resulted in stable fixation of the unstable (dorsally or volarly displaced intraarticular) distal articular fragments, allowing early postsurgical wrist motion (functional outcome) and having excellent to good radiological outcome. The fracture fixation with volar plate and screw system in the management of distal radius articular fractures, especially in type C ( Complete intraarticular fractures ) is a superior method to maintain the reduction till union and prevent the collapse of the fracture fragments, even in grossly comminuted , unstable and osteoporotic bones ; as compared with external fixator augmented with K – wires. However in type B ( partial intraarticular fractures ) fractures, Volar LCP and K- wire augmented External fixator provide equivocal results and none is proved superior. Ligamentotaxis by external fixation provided favourable results in younger age group and in partial intra- articular type of distal radius fractures and requires atleast 4 cortical purchases on each side for effective stability. However long term follow-up is required to confirm our findings