桡骨远端骨折文献2

478Acta Orthopaedica 2009; 80 (4): 478–485Open reduction and internal xation compared to closed reduction and external xation in distal radial fractures

A randomized study of 50 patients

Antonio Abramo1, Philippe Kopylov1, Mats Geijer2, and Magnus Tägil1

1Hand Unit, Department of Orthopedics, Clinical Sciences, Lund University; 2Department of Radiology, Lund University Hospital, Sweden

Correspondence: tony.abramo@med.lu.se

Submitted 08-04-22. Accepted 09-02-22

Background and purpose In unstable distal radial fractures that

are impossible to reduce or to maintain in reduced position, the

treatment of choice is operation. The type of operation and the

choice of implant, however, is a matter of discussion. Our aim was

to investigate whether open reduction and internal xation would

produce a better result than traditional external xation.

Methods 50 patients with an unstable or comminute distal

radius fracture were randomized to either closed reduction and

bridging external xation, or open reduction and internal xa-

tion using the TriMed system. The primary outcome parameter

was grip strength, but the patients were followed for 1 year with

objective clinical assessment, subjective outcome using DASH,

and radiographic examination.

Results At 1 year postoperatively, grip strength was 90% (SD

16) of the uninjured side in the internal xation group and 78%

(17) in the external xation group. Pronation/supination was 150°

(15) in the internal xation group and 136° (20) in the external

xation group at 1 year. There were no differences in DASH

scores or in radiographic parameters. 5 patients in the external

xation group were reoperated due to malunion, as compared to

1 in the internal xation group. 7 other cases were classi ed as

radiographic malunion: 5 in the external xation group and 2 in

the internal xation group.

Interpretation Internal xation gave better grip strength

and a better range of motion at 1 year, and tended to have less

malunions than external xation. No difference could be found

regarding subjective outcome.

N(Handoll and Madhok 2003a). The subject of our study is: fractures that are primarily impossible to reduce or impossible to retain in an acceptable position. These fractures are often considered necessary to operate. The type of operation and the choice of implant is still, however, a matter of discussion; a Cochran report has stated that “randomized trials do not provide robust evidence for most of the decisions necessary in the management of these fractures” (Handoll and Madhok 2003b).At our department, 2 types of surgical interventions have been used over the last decade for the treatment of distal radius fractures. The TriMed fragment-speci c system (Schnall et al. 2006), is used preferably in younger patients whereas external xation has been used more in older patients, but is still an acceptable option in all age groups. The present randomized study was conducted to compare closed reduction combined with external xation—which has been or still is the standard operation in many hospitals—to the more complex and more technically demanding open reduction and internal xation. Our aim was to determine whether a more accurate reduction could be achieved and retained during healing, and whether the outcome—both objective and subjective—could be improved by internal fragment-speci c xation methods, compared to external xation. The study allowed the best possible opera-tion performed either openly or closed—thus allowing for additional pins, bone substitute, or graft if deemed necessary. As primary outcome, we chose grip strength at 7 weeks and 12 months postoperatively and as secondary outcome we chose

the DASH score at the same 2 time points.

Distal radial fractures account for about one-sixth of the frac-

tures seen in the emergency room, with an annual incidence

of 26 per 10,000 inhabitants in Sweden (Brogren et al. 2007).

Non-operative treatment using plaster cast is chosen in non-

displaced fractures and in displaced, but reducible fractures Patients and methodsPatientsAt our department, all patients with a distal radial fracture are Open Access - This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.

DOI 10.3109/17453670903171875

Acta Orthopaedica 2009; 80 (4): 478–485 Table 1. The inclusion and exclusion criteria for the study

treated according to a treatment protocol (Abramo et al. 2008).

Non-displaced fractures are treated in a plaster cast for 4–5

weeks. Displaced fractures are reduced and casted. If the frac-

ture after reduction is unstable or even impossible to primarily

reduce (for de nitions, see Table 1), surgical treatment is sug-

gested to the patient. Patients with fractures in the AO groups

A1–3 and C1–3 were eligible for the study. These patients

were invited to participate in a randomized study comparing

open and closed treatment. The study was approved by the

local ethics committee (no. Lu 45/02).

Between May 2002 and December 2005, 50 patients (36

women) with a mean age of 48 (20–65) years with unstable

fractures ful lled the inclusion criteria (Table 1). Most patients

with a distal radius fracture were older than 65 years and were

not eligible for the study. Patients with a redislocated frac-

ture were also not eligible for the study. Thus, only younger

patients with an unstable fracture who were in need of an

acute operation were recruited, thus explaining the relatively

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