title: Treatment of unstable distal radius fractures: non-invasive dynamic external fixator versus volar locking plate - functional and radiological outcome in a prospective case-controlled series.
abstract: BACKGROUND
  Distal radius fracture (DRF) is a common injury and various treatment modalities including open reduction and internal fixation (ORIF) with volar locking plate are available. More recently, a non-invasive external fixator has been used.
  
  
  OBJECTIVE
  To prospectively compare the use of a non-invasive external fixator with early dynamisation for DRF against ORIF with volar locking plate control group.
  
  
  METHODS
  Consecutive patients with closed DRF were included in a prospective case-controlled study. Patients were assigned to non-invasive external fixator or ORIF. Minimum follow-up was two years. Follow-up was at weeks 2, 4, 6, 8, 12, 26 and at one and two-year post-operatively. The outcome measures included demographic details, injury mechanism, AO fracture type, risk factors, body mass index (BMI), ulnar styloid fracture and dorsal comminution, radiographs, grip strength and DASH score.
  
  
  RESULTS
  Consecutive 50 patients were treated either with non-invasive external fixator (25/50) or with ORIF (25/50) and the mean age of the two groups was 53 years (SD 17.1) and 49 years (SD 19.5), respectively. Demographics were matched in two groups. In the non-invasive external fixator group, there were 10 AO Type-A, 5 Type-B and 10 Type-C fractures. The ORIF group included 8 Type-A, 6 Type-B and 11 Type-C fractures. The mean DASH score at three-months and one-year post-injury in non-invasive fixator group was 12.2 (SD 3.1) and 3.5 (SD 0.7), respectively, significantly greater than those of ORIF group 14.5 (SD 5.6) and 11.2 (SD 4.4), respectively (p < 0.05).
  
  
  CONCLUSIONS
  DRF treated with non-invasive external fixator can give functional results superior to ORIF at three-months and the trend is maintained at one and two-year post-operatively.
authors.affiliation: Villar Bajwa Practice (London and Cambridge) 30 Devonshire Street London W1G 6PU UK ; James Cook University Hospital Marton Road Middlesbrough TS43BW UK.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Bajwa
authors.affiliation: University Hospital of North Durham North Road Durham DH15TW UK.
authors.forename: Manju
authors.initials: M
authors.lastname: Rammappa
authors.affiliation: James Cook University Hospital Marton Road Middlesbrough TS43BW UK.
authors.forename: Ling
authors.initials: L
authors.lastname: Lee
authors.affiliation: University Hospital of North Tees Hardwick Road TS198PE Stockton-on-Tees UK.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Nanda
keywords: Distal radius fracture; Functional result; Non-invasive fixator; external fixture; volar locking plate