Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of De Palma percutaneous pinning versus bridging external fixation.
BACKGROUND
At present, there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius. This study compared the effectiveness of two methods used in surgical treatment of such fractures: percutaneous pinning and external fixation.


METHODS
We randomly allocated 100 patients into two groups treated surgically with modified De Palma percutaneous pinning and bridging external fixation. Independent but not blinded evaluators administered the DASH quality-of-life questionnaire at postoperative months 6 and 24, performed functional assessment of pain, range of motion, and palm grip strength, and radiographic examinations (volar and radial angle, and height of the radius) before the operation, immediately afterwards, and at 6 and 24 months postoperative. Modified De Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery. Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been randomised according to the intention-to-treat principle. A significance level of 5% (alpha = 0.05). was used for all statistical tests, such that tests presenting a p-value less than 0.05 were considered statistically significant.


RESULTS
Ninety one (58.8 mean age and 66 participants were female) were included in the final assessment at 24 months. The DASH questionnaire evaluation showed a statistically significant result favouring the De Palma group (mean difference = -7.1 p = 0.044) after six months, but this was not maintained at 24 months. There were no statistically differences between the groups with respect to palm grip strength. Analysis of the range-of-motion limitation index (uninjured side minus affected side motion of) showed a statistical difference (mean difference = 2.4 p = 0.043) favoring the external fixator group with regard to the supination movement 6 months after the operation; however, this was not maintained at 24 months. The final results of the radiographic evaluation were similar for the two groups. Overall, five patients developed complications: two with De Palma pinning and three with external fixation.


CONCLUSIONS
There was a small statistically significant difference favouring the De Palma method in early functional at 6 months according to the DASH questionnaire, and for supination movement favouring the fixator group. However, both were not clinical relevant. By 24 months the groups were similar for all outcomes


BACKGROUND
Current Controlled Trials ISRCTN04892785.
Belloti
João C
JC
Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo 04038-032, Brazil.
Tamaoki
Marcel J S
MJ
Atallah
Alvaro N
AN
Albertoni
Walter M
WM
dos Santos
João B G
JB
Faloppa
Flavio
F
D000328:Adult; D000368:Aged; D001858:Bone Nails / Q000592:standards; D016267:External Fixators / Q000592:standards; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D017063:Outcome Assessment, Health Care; D011859:Radiography; D011884:Radius / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome