External fixation of distal radius fractures usually involves the use of a bridging fixator. However, immobilisation of the wrist can be associated with various complications and therefore dynamic external fixators were developed to allow wrist mobilisation with the fixator in place. But dynamic fixators themselves are not without complications and more recently interest has been rekindled in non-bridging external fixators (otherwise called metaphyseal or radial-radial fixators).

Following a pilot study using a non-bridging external fixator (Delta frame) in the treatment of intra-articular distal radius fractures, our aim in this study was to compare the functional and radiological outcome of the Delta frame and a standard wrist-bridging static external fixator in the treatment of such fractures. Sixty patients with intra-articular distal radius fractures were randomly allocated to receive either a static bridging Hoffman external fixator or a non-bridging Delta frame. All patients had the fixator removed at six weeks. Clinical and radiographic assessment was performed regularly up to a maximum of twelve months with the clinical results being expressed in terms of range of movement, pain, grip strength and ability to perform certain activities of daily living. Radiological assessment was performed by an independent radiologist. Mean follow-up was ten months.

The only sustained significant difference in function was a greater range of flexion in the Hoffman group. No significant difference could be detected between the two groups in terms of the radiological outcome. Complications included pin-site infection, paraesthesia, extensor pollicis longus tendon rupture and chronic regional pain syndrome. Three patients underwent further surgery. We did not demonstrate any advantage in the use of a non-bridging fixator in the treatment of intra-articular distal radius fractures.

Introduction: Current fixation methods for distal radial fractures usually involve immobilisation, which has been suggested to have adverse effects on wrist function. The aims of this study were to compare the clinical, functional and radiological outcomes of a bridging, and a non-bridging external fixator that did not cross the wrist joint, in the management of intra-articular fractures of the distal radius.

Methods: Sixty subjects were randomly allocated to receive a bridging Hoffman frame and limited wrist range of movement (ROM) exercises for 6 weeks, or a non-bridging Delta frame and full active wrist ROM exercises commencing at 2 weeks. All frames were removed at 6 weeks. Radiographic and clinical assessments were made at regular postoperative time intervals for 12 months with clinical outcomes including measures of pain, ROM, grip strength, function and quality of life.

Results: Preliminary clinical results analysing pain, grip strength and ROM including flexion, extension, pronation and supination at 1–6, 26 and 52 weeks postoperatively indicated that no statistically significant difference could be detected between the two groups at any time frame. Complication rates were similar for both groups. Preliminary radiographic analysis of dorsal angle, radial angle and radial length at 6, 26 and 52 weeks postoperatively also indicated that no statistically significant difference could be detected between the two groups.

Conclusion: Preliminary results of this trial suggest that no difference can be detected in the clinical and radiographic outcomes of subjects receiving a bridging external fixator with limited early wrist ROM exercises, or a non-bridging external fixator with early full active ROM exercises in the management of intra-articular fractures of the distal radius.

Introduction: THR and TKR have been shown to be successful treatments for moderate to severe osteoarthritis of the hip and knee. The requirement for total joint replacement will increase as the population ages. This study reports on the incidence of THR and TKR in an Australian population.

Method: Age and gender specific numbers of THR and TKR for the Australian population, 1994–1998 were obtained from the Australian Institute of Health and Welfare. The same data for South Australia, 1988–1998 were obtained from the Department of Human Services Epidemiology Branch. The incidences were calculated and tested for changes over time.

Results: For the Australian population in 1994 there were 9,120 THR and by 1998 this had increased by 25.9% to 11,488 THR. There were 10,132 TKR in 1994 and by 1998 this had increased by 42.8% to 14,472 TKR. Stratified by age group changes in incidence rate with respect to time was statistically tested using regression analysis. For the eleven year data from South Australia there was a significant increase in the overall incidence of THR (p=0.012). There were significant increases in TKR incidence, although this increase was not uniform across all age groups (p< 0.001). The increase in TKR incidence was greater than that for THR. For both THR and TKR there were no significant differences on the basis of gender.

Conclusion: The incidence of THR is increasing in Australia and TKR incidence is increasing at a greater rate. Future projections must take into account these changing incidences as well as changes in population demographics.