Comparative analysis of external and internal fixation in lower radial articular fractures

Background: The treatment of distal radial articular fracture is still controversial despite continue refinement in the treatment. Objectives: The study was done to compare the functional as well as radiological outcome of treatment of distal radius by the external fixation frame and internal fixation by plating. Materials and Methods: This prospective study was conducted in a tertiary care hospital of eastern India on 40 patients with distal radial articular fractures after taking clearance from the Institutional Ethical committee and informed consent of the patients. All cases of distal radial articular fractures were randomly assigned by computerized methods to two different treatment protocols: a) external fixation application and b) internal fixation application. The fractures were classified with Fernandez and Jupiter classification. Results: In the present study excellent results were obtained in all Fernandez type I fractures both in external fixation and internal fixation group. Excellent to good results were obtained in all Fernandez type II fractures both in external fixation and internal fixation group. In external fixation group, out of six type II fracture four (66%) had excellent result and two (33%) had good result. In internal fixation group out of nine type II fracture five (55%) had excellent result and four (45%) had good result. Mixed results were obtained in all Fernandez type III fractures (16) both in external fixation and internal fixation group. In external fixation group, out of eight type III fracture 3(38%) had excellent result, four (50%) had good result and one (12%) had fair result. In internal fixation group out of eight type III fracture six (75%) had excellent result and two (25%) had good result. The results indicate that in type III fractures internal fixation is a better option. Fair to poor results were obtained in Fernandez type V (3) fractures both in external fixation and internal fixation group. Results may be improved by early bone grafting and possible external fixation and internal fixation (combined fixation). Out of thirteen patients with biplanar JESS, eight (61%) had excellent results compared to uniplanar UMAX in which out of seven, patients three (42%), had excellent results. Conclusions: External fixation and volar buttress plate produce almost equivalent functional results in distal radial articular fractures, with volar buttress plate having better anatomical results than external fixation in the present study. With careful assessment, good surgical technique and early mobilization, the distal radial articular fractures can be effectively managed with predictably good outcome using either external fixation or volar buttress plate. Volar buttress plate can be more effective in type III Fernandez fractures, while UMAX is a better option for Fernandez type II fractures