This prospective randomized multicenter trial compares the use of external fixation and percutaneous pin fixation with plate fixation for intra-articular distal radius fractures in patients less than sixty years of age. One hundred and thirty seven patients with 144 intra-articular distal radius fractures were recruited with an average age of 42 years at the time of fracture. Patients were randomized to the two treatment groups with postoperative follow up at six, twelve, and twenty-four months. According to the Gartland and Werley clinical system, as well as the arthritis grading scale, there was a statistical benefit in the plate fixation group at the twenty-four month follow up compared to the external fixation group, especially for the AO group-C2 fractures which are simple articular fractures with a comminuted metaphyseal region. There was loss of reduction in five wrists in both groups. In addition there were five pin-track infections and three superficial infections in the external fixation group compared to three patients with a superficial infection in the plate fixation group which healed with antibiotics alone. Three patients in the external fixation group developed a superficial radial nerve irritation and one patient developed a type I complex regional pain syndrome. Of the seventy patients treated with a plate, thirty fractures were treated with a dorsal plate, which were all routinely removed to minimize chance of tendon ruptures. Only one patient in the plate group developed extensor pollicis longus tendonitis which was noted at the time of routine implant removal.
This is only the second multicenter prospective randomized study to evaluate surgical treatment options including plate fixation of intra-articular distal radius fractures. Despite the trend that has been towards volar plating with the newer locking plate technology, this is the first study to show an advantage or benefit of this more invasive technique of fixation. The advantage was most notable in the C2 group with respect to outcome at two years and arthritic grade. This outcome does contrast with those by Kreder et al. that noted that percutaneous fixation and external fixation was associated with more rapid return of function and better functional outcome when compared with plate fixation. The study design was slightly different with respect to the use of supplemental external fixators with plate fixation and the increased use of dorsal plating in this previous study. Therefore, further studies are necessary to elucidate the outcomes related to these treatment methods.