Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation Versus Bridging External Fixation

Background: Distal radius fracture is common in all ages. Mobility and wrist function is important. The choice of treatment should aim for optimal function with minimal complications. Objectives: In this study we compared two surgical approaches, open reduction and internal fixation (ORIF) and closed reduction with external fixation (CR + EF), for treatment of intra-articular distal radius fractures. Patients and Methods: Ninety-four patients with distal radius fracture (type ۳, ۴ and ۵ Fernandez classification) were treated with two surgical methods (ORIF and CR + EF); ۵۵ were treated with CR + EF and ۳۹ were treated with ORIF by different surgeons. All patients were assessed at the end of the first, third and sixth week; and then after the third, sixth and ۱۲th month. At the end of the follow-up, all patients completed the Michigan hand outcome questionnaire (MHOQ). We compared radiological parameters of distal radius, range of motion (ROM) of the wrist, duration of rehabilitation, complication and patient satisfaction of the methods. Results: In our study, radiological findings for the ORIF group were radial inclination (RI): ۱۹.۳۵, radial length (RL): ۱۰.۳۵, radial tilt (RT): ۸.۹۲, and ulnar variance (UV): ۱.۶۴, while for the CR + EF group these were RI: ۱۵.۱۳, RL: ۸, RT: ۴.۷۸, and UV: ۰.۲۷. The ROM for ORIF were flexion/ extension (F/E): ۱۳۷, Radial/Ulnar deviation (R/U): ۵۲, and Supination/Pronation (S/P): ۱۴۱, while for the CR + EF group these were F/E: ۱۱۷, R/U: ۴۰ and S/P: ۱۱۶. Michigan hand outcome score for ORIF was ۷۵% and for Ext. fix was ۶۰%. The rate of complication with the ORIF method was ۵۸% and in Ext. fix this was ۶۹%. The patients in CR + EF had more than the ORIF course of physiotherapy and rehabilitation. Conclusions: In comparison of ORIF and CR + EF, all results including functional score, clinical and radiologic criteria were in favor of the ORIF method while there were less complications with this method. We believe that ORIF is a better method for treatment of these types of fractures.