title: Dynamic vs static external fixation of distal radial fractures: A randomized study.
abstract: OBJECTIVE
  The present randomized study is conducted to compare the functional and anatomical outcomes of dynamic multiplanar external fixation against that of static external fixation in the management of displaced unstable comminuted fractures of the distal radius.
  
  
  METHODS
  Sixty adult patients with displaced unstable comminuted fractures of the distal radius were randomly allocated either to the dynamic (n=30) or static (n=30) fixator groups. Patients in the dynamic fixator group were managed with closed reduction and application of Penning-type articulated fixator (Orthofix, Srl, Italy); the injured wrist was partially dynamized at 3 weeks. Patients in the static group were managed with monoplanar static external fixator of Joshi's external stabilizing system (JESS) type fixator. In both groups, the fixator was maintained for 6-8 weeks. The patients were followed-up over 2 years. The primary outcome measures were the functional outcome as measured using the Gartland and Werley and DASH scores and anatomical outcome as measured using the Lindstrom score. The secondary objective was to correlate anatomical and functional outcomes and to look at overall local complications.
  
  
  RESULTS
  Palmar tilt was better restored in the Penning fixator group (P<0.0001). There was reduced loss of ulnar tilt (P=0.05) and radial height (P=0.04) in the Penning fixator group. Gartland and Werley score was better in the Penning fixator group at each time point of the follow-up. The DASH score was similar in the two groups at 2 years (P=0.14). There was poor correlation (0.19) between functional outcome and anatomical restoration at 2 years.
  
  
  CONCLUSIONS
  In the management of displaced unstable comminuted fracture of the distal radius, use of an articulated multiplanar external fixator, allowing partial dynamization of the injured wrist at 3 weeks, resulted in improved early functional and anatomical outcome as compared to static external fixation. However, there was no significant difference in functional outcome at 2 years.
authors.affiliation: Classified Specialist Orthopaedics, Command Hospital Air Force, Bangalore.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kulshrestha
authors.forename: Tanmoy
authors.initials: T
authors.lastname: Roy
authors.forename: Laurent
authors.initials: L
authors.lastname: Audige