External Fixation Versus Open Reduction And Internal Fixation For Unstable Distal Radius Fracture In Adults: A Systematic Review

Objective: We performed a comprehensive systematic review and meta-analysis of the current literature on external fixation and internal fixation of the unstable distal radius fractures to determine the dominant strategy based on available scientific evidence.Methods: Electronic search databases (Cochrane central register of controlled trials,Medline,EMbase and the China Biological Medicine Database (CBM),China National Knowledge Infrastructure (CNKI) searched to November 2010 and contact with experts. Only prospective randomized controlled trials (RCTs) that comparing external fixation(EF ) with open reduction and internal fixation (ORIF)for treatment of the unstable distal radius fracture in all adults are included in a meta-analysis regarding DASH scores,grip strength,,range of motion and complications.The analysis was performed with software RevMan5.0 and Gradepro3.2 from the Cochrane collaboration and we draw the forest plot.Results: we identified 6 relevant randomized controlled trials with a total of 432 participants.The meta-analysis showed comparing EF group,ORIF group has a significant better DASH scores at six and twelve month( MD=5.47,95%CI=1.16~9.77,P=0.01 ),( MD=8.71,95%CI(2.04～15.38),P=0.01).The grip strength and the range of motion of the wrist were not significant different between EF and ORIF group at twelve months follow-up,but all had a better improved than three months after surgery. A better radiographic outcome of volar tilt at twelve months in ORIF group than EF group(MD=-4.59,95%CI=-7.12~-2.07,P=0.0004),But no difference were found at the rest of radiographic outcomes and the number of complications between EF and ORIF group at twelve months follow—up.Conclusions: From the exist evidence,our findings suggest that an statistically significant improved DASH scores outcome at six and twelve months after open reduction and internal fixation,and a better radiographic outcome of volar tilt at one year in open reduction and internal fixation.But the actual difference was of little clinical significance.