Open reduction and internal fixation versus external fixation and/or kirschner wires for distal radius fractures. A systematic review.

UNLABELLED The aim of this study was to compare open reduction and plate fixation in the treatment of distal radius fractures with percutaneous fixation methods (external fixation and/or K-wires) regarding the outcome, using self-reported questionnaires (PRWE--Patient rated wrist evaluation, DASH--Disabilities of the Arm, Shoulder and Hand) as a primary aim, and grip strength and radiological parameters as a secondary aim. DATA SOURCE We performed a systematic review of available evidence through a search of the electronic Medline PubMed database. STUDY SELECTION Randomized clinical trials were included, as well as nonrandomized retrospective studies if they directly compared percutaneous fixation with ORIF, in the last ten years. DATA EXTRACTION Functional (PRWE, DASH), objective (grip strength), as well as radiographic outcomes were extracted and reported. DATA SYNTHESIS Ten studies were analysed, a total of 647 distal radius fractures (DRF) were included in the meta-analysis, 140 fractures treated with external fixation, 179 with K-wires (total 319 percutaneous fixation), and 328 fractures treated with ORIF. The meta-analysis showed no statistically significant differences between the results for the DRF treatment with ORIF or percutaneous methods at 3, 6 and 12 months regarding PRWE scores and grip strength, as well as final radiological outcome (volar tilt, radial length, radial tilt, ulnar variance). At 3 and 6 months there was a significant difference in the DASH score favouring open reduction and plate fixation, but at 12 months the meta-analysis showed no significant difference between the two methods compared. CONCLUSIONS The results of this meta-analysis for the operative treatment of distal radius fractures did not clearly demonstrate a relevant advantage of any of the fixation methods.