title: Open reduction and internal fixation versus external fixation for unstable distal radial fractures: a meta-analysis.
abstract: OBJECTIVE
  To compare the clinical outcomes of open reduction and internal fixation (ORIF) versus the ones of closed reduction and external fixation (EF) in the treatment of distal radial fractures.
  
  
  METHODS
  We performed a meta-analysis of randomized controlled trials that compared the clinical results of ORIF to EF in the treatment of distal radial fractures. A systemic retrieve from PubMed, EMBASE, OVID and Cochrane Collaboration CENTRAL database resulted in 11 studies with 824 patients. We thus performed data synthesis using RevMan (version 5.1).
  
  
  RESULTS
  Superior statistical differences were observed for DASH scores (at 3, 6 and 12 months follow-up) grip strength (at 3 months follow-up), volar tilt (at 12 months follow-up), flexion and supination (at 3 months follow-up), and extension (at 3 and 6 months follow-up) in ORIF patients group, compared with those in EF group. We also found a significantly higher risk of infection associated with EF. There was no significant difference in the incidence of malunion and median nerve dysfunction.
  
  
  CONCLUSIONS
  Regarding surgical fixation of unstable distal radius fractures, ORIF yields significantly better subjective outcome (DASH scores) the first year after operation, restoration of anatomic volar tilt, and forearm flexion and extension at the end of the follow-up period. However, EF results in higher incidence of infection compared to ORIF. ORIF is equal to EF for either grip strength, or range of motion of the injured wrist, or incidence of malunion or median nerve dysfunction at the end of the follow-up period.
  
  
  METHODS
  Level II. Therapeutic study.
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154, Anshan Street, Heping District, 300052 Tianjin, China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
authors.forename: J
authors.initials: J
authors.lastname: Ma
authors.forename: D
authors.initials: D
authors.lastname: Xing
authors.forename: S
authors.initials: S
authors.lastname: Zhu
authors.forename: B
authors.initials: B
authors.lastname: Ma
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.forename: X
authors.initials: X
authors.lastname: Ma
mesh_terms: D016267:External Fixators; D005592:Fracture Fixation / Q000009:adverse effects; D005593:Fracture Fixation, Internal; D018737:Hand Strength; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011885:Radius Fractures / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology