Background: There is no consensus on the surgical management of unstable distal radius fractures. In this systematic review and meta-analysis, we pool data from trials comparing external fixation and internal fixation for treatment of this injury.

Methods: We searched electronic databases and conference proceedings for published and unpublished trials. Two authors independently screened titles and s, reviewed manuscripts, graded methodological quality, and extracted all relevant information from eligible studies. Data were pooled using fixed-effects and random-effects models with standard mean differences (SMD) and risk ratios for continuous and dichotomous variables, respectively. Heterogeneity across studies was assessed with Forest plots and calculation of the I2 statistic. Subgroup analyses were defined a priori and performed where appropriate.

Results: We pooled data from nine comparative trials, totaling 750 patients (360 fractures treated with external fixation and 397 with internal fixation). Initially, we found substantial heterogeneity between studies and no significant difference according to our primary outcome measure, validated patient-reported outcomes (SMD=0.20, 95% confidence interval=[−0.12, 0.51], p=0.22, I2=65%). However, when we grouped studies by plate type, we eliminated heterogeneity within each subgroup and found locking volar plates demonstrated significantly better patient-reported outcomes compared to external fixation (SMD=1.30, 95% CI=[0.74, 1.86], p< 0.00001, I2=0%). Additionally, we found internal fixation yielded significantly better recovery of forearm supination and restoration of volar tilt (SMD=0.31, 95% CI=[0.15, 0.47], p=0.0002, I2=0; SMD=0.57, 95% CI=[0.57, 0.78], p< 0.00001, I2=0, respectively). Subgroup analyses showed external fixation yielded better wrist flexion among randomized studies (SMD= 0.43, p< 0.003, 95% CI=[ 0.67, 0.20], I2=0), and there was no significant difference in grip strength among studies with high methodological quality (SMD= 0.08, 95% CI=[−0.34, 0.18], p=0.54, I2=0%).

Conclusions: Open reduction and internal fixation of unstable distal radius fractures yields greater recovery of forearm supination, better restoration of anatomic volar tilt, and, for locking volar plates in particular, superior patient-reported function. External fixation may result in better wrist flexion, but no difference exists in terms of grip strength.

Purpose: Distal radius fractures are common and rising in incidence as orthopaedists treat an increasingly aged population. Both external fixation and volar plating have demonstrated satisfactory results, however the orthopaedic literature lacks comparative data on radial column plating. The purpose of this prospective study was to compare functional and radiographic data from patients randomized to three surgical modalities – external fixation, volar plating, and radial column plating.

Method: This study included 40 patients with closed, unilateral, unstable distal radius fractures distributed as follows: 20 patients treated with external fixation, 10 patients with volar plating, and 10 patients with radial column plating. When classified according to the OTA system, the fractures included types A3, B3, and C1 C3. Patients were followed post-operatively at 2, 4, 6, 12, 24, and 52 weeks. At each visit, patients completed a DASH questionnaire, grip and lateral pinch strength, and range of motion for both wrists. Radiographs were evaluated for lateral tilt, radial inclination, ulnar variance and radial height. Statistical analyses employed single-factor three-way ANOVA of all outcomes at each follow-up period.

Results: No significant difference (p> 0.05) was found between mean DASH scores at each follow-up period for all three patient groups. However, each group achieved significant improvement in DASH scores at 1-year follow-up compared to baseline scores (external fixation, p0.05), with final flexion-extension and supination-pronation ranging 78–94% and 92–96% (of the un-injured wrist), respectively. All radiographic measurements demonstrated no significant differences. Reduction was maintained among all three groups without implant failure or complications.

Conclusion: At all follow-up periods, analysis of functional and radiographic outcomes showed no significant difference among all groups. Based on this data, no one method of fixation is superior to the others, giving orthopaedists multiple options for surgically reducing the unstable distal radius. Moreover, the diversity in approach of these methods allows additional flexibility in selecting an appropriate technique for each patient.