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Scientific Articles   |    
Dynamic Compared with Static External Fixation of Unstable Fractures of the Distal Part of the RadiusA Prospective, Randomized Multicenter Study
Leiv M. Hove, MD, PhD1; Yngvar Krukhaug, MD, PhD2; Kåre Revheim, MD3; Per Helland, MD2; Vilh Finsen, MD, PhD4
1 Department of Surgical Sciences, University of Bergen, N-5021 Bergen, Norway. E-mail address: leiv.hove@kir.uib.no
2 Department of Orthopaedic Surgery, Haukeland University Hospital, N-5021 Bergen, Norway
3 Department of Orthopaedic Surgery, Stavanger University Hospital, N-4068 Stavanger, Norway
4 Department of Orthopaedic Surgery and Neuroscience, St. Olav's University Hospital NTNU, N-7006 Trondheim, Norway
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Norwegian Industrial and Regional Fund (SND). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Haukelaud University Hospital, Bergen; Stavanger University Hospital, Stavanger; and St. Olav's University Hospital, Trondheim, Norway

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jul 21;92(8):1687-1696. doi: 10.2106/JBJS.H.01236
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Abstract

Background: 

External fixation is an established method of treating certain types of distal radial fractures. We have designed a dynamic external fixator to treat these fractures. The purpose of the present study was to compare this device with current static bridging external fixators in terms of anatomical and functional results.

Methods: 

We conducted a prospective randomized study to compare the radiographic and clinical results of dynamic external fixation with those of static external fixation for the treatment of seventy unstable distal radial fractures. Mobilization of the wrist was begun in the dynamic fixator group on the day after surgery. The external fixation frames were kept in place for a mean of six weeks. The patients were assessed clinically and radiographically at the time of removal of the fixator and at three, six, and twelve months.

Results: 

Dynamic fixation resulted in a significantly better restoration of radial length at all follow-up visits in comparison with static fixation. There were no significant differences in radial tilt or radial inclination between the two groups. Wrist flexion, radial deviation, and pronation-supination were regained significantly faster in the dynamic fixator group. Wrist extension was significantly better in the dynamic fixator group in comparison with the static fixator group at all follow-up times. Self-evaluation with use of the Disabilities of the Arm, Shoulder and Hand score and a visual analog pain score demonstrated no significant differences between the two groups at the time of the latest follow-up. Superficial pin-track infections were significantly more common in the dynamic external fixator group than in the static fixator group.

Conclusions: 

Continuous dynamic traction with a dynamic external fixator compares favorably with the use of static external fixators for the treatment of unstable fractures of the distal part of the radius.

Level of Evidence: 

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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