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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 9,
1214-1221.
doi: 10.1302/0301-620X.90B9.20521 Copyright © 2008 by British Editorial Society of Bone and Joint Surgery Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radiusA RANDOMISED, PROSPECTIVE TRIALK. Egol, MD, Associate Professor1; M. Walsh, PhD, Assistant Professor1; N. Tejwani, MD, Associate Professor1; T. McLaurin, MD, Assistant Professor1; C. Wynn, BA, Researcher1; and N. Paksima, DO, Assistant Professor11 Department of Orthopaedic Surgery The New York University Hospital for Joint Diseases, 301 East 17th Street, New York, New York 10003, USA. Correspondence should be sent to Professor K. Egol; e-mail: egolk01{at}nyumc.org
We performed a prospective, randomised trial to evaluate the outcome after surgery of displaced, unstable fractures of the distal radius. A total of 280 consecutive patients were enrolled in a prospective database and 88 identified who met the inclusion criteria for surgery. They were randomised to receive either bridging external fixation with supplementary Kirschner-wire fixation or volar-locked plating with screws. Both groups were similar in terms of age, gender, hand dominance, fracture pattern, socio-economic status and medical co-morbidities. Although the patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist, this advantage diminished with time and in absolute terms the difference in range of movement was clinically unimportant. Radiologically, there were no clinically significant differences in the reductions, although more patients with AO/OTA (Orthopaedic Trauma Association) type C fractures were allocated to the external fixation group. The function at one year was similar in the two groups. No clear advantage could be demonstrated with either treatment but fewer re-operations were required in the external fixation group.
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