Dynamic and static external fixation for distal radius fractures--a systematic review.

INTRODUCTION External fixation of distal radius fractures may be static (wrist-bridging) or dynamic (wrist-bridging with mobile hinge or non-bridging). The aim of this systematic review is to investigate the effectiveness of different methods of external fixation for unstable distal radius fractures. METHODS A Medline database search was performed with strict eligibility criteria to obtain the highest quality evidence from meta-analyses, RCTs and comparative studies. Eligible studies were critically appraised using levels of evidence and RCTs were further appraised using a validated scoring tool. RESULTS Fifty-four studies were identified of which eight were included. There were six RCTs and two retrospective comparative studies. Three RCTs compared non-bridging with static wrist-bridging fixation. Two RCTs compared dynamic wrist-bridging with static wrist-bridging fixation. One study compared dynamic wrist-bridging with non-bridging fixation. The RCTs varied in quality and scored between 12 and 23 out of a maximum of 33 points. The evidence suggests that there are no functional or radiological benefits for a dynamic wrist-bridging external fixator with a mobile hinge joint over a static wrist-bridging external fixator. The evidence also suggests that there are no benefits for non-bridging over static wrist-bridging external fixation in older patients but there do appear to be clear benefits both functionally and radiologically when considering patients of all ages. CONCLUSION Dynamic and static external fixators both achieve good outcomes for patients with unstable distal radius fractures with comparable complication rates. Non-bridging fixation may result in better functional and radiological results than static wrist-bridging fixation when considering patients of all ages with earlier return of function. This benefit does not seem apparent when considering older patients. Although a benefit was not seen in this group, the technique may have practical advantages over wrist-bridging fixation by allowing increased mobility and use of the limb during the fixation period and enabling such patients to maintain their independence. Cost effective analyses are required to assess whether this would be an economically viable option for this group of patients.