Background: Distal radius fractures are among the most common fractures, consisting of about 1/6 of all fractures shoving up at the ER. Many times surgical treatment is indicated. However which type of operation to chose is not known. The standard operative treatment has been external fixation but more modern techniques for internal fixation have become increasingly popular. Our aim was to evaluate if internal fixation is beneficial for the patients. To do this we did this randomized study.

Material and methods: Between May 2002 and March 2005 a randomized study between closed reduction and external fixation versus open reduction and internal fixation with the TriMed® system was performed in 42 consecutive patients. 29 were women and 13 were men in the ages between 20 and 63 with a mean age of 48 years. 20 were randomized to closed treatment and 22 to open treatment. Patients were followed with clinical examination, radiographs, examination of range of movement and grip strength and outcome measured by DASH for one year.

Results: DASH-scores showed no statistical significant differences between the groups neither early at seven weeks (32 in the open group an 29 in the closed) nor late at one year (9 vs. 13) postoperatively. Range of movement in flexion and extension was better in the internal fixation group at 5 weeks (45 degrees vs. 67) degrees postoperatively but this difference disappeared at one year (121d egrees in both groups). Grip strength was significantly better for the TriMed group at 5 weeks (32% of the opposite side vs. 8% in the external fixation group) and 7 weeks (47% vs. 34%) and at one year (78% vs. 90%) postop. Range of movement in forearm rotation was significantly better in the open group during the whole follow up (126deg. vs. 101deg. at seven weeks and 149 vs. 133 at one year). There were three cases of redislocation in the external fixation group. They were all later treated with osteotomy. However there were 15 cases of minor complications in the open group compared to 9 cases in the closed group. The minor complications were mainly consisting of transient tingling of the radial nerve in the open group and skin adherences in the closed group.

Conclusion: Open reduction and internal fixation for distal radial fractures give better result regarding motion and grip strength than External fixation but there is no difference in subjective outcome. Complications are common in both groups but these are often minor non lasting complications. However malunion is more common with external fixation.

Background: Distal radius fractures are the most common fractures at the ER and constitute about 1/6 of all fractures. We report the patient related outcome scores as measured prospectively and consecutively with the DASH- score (Disabilities of the Arm Shoulder and Hand) in an unselected cohort of distal radius fractures. It is often stated that fractures in a non-osteoporotic age group were more severe than in an elderly group.

Materials and Methods: 542 patients, at the age of 18 and above with a distal radius fracture were registered between September 2001 and June 2003,. Age, gender and treatment were registered and DASH-forms sent to the patients at 3 and 12 months post fracture. 50 patients were excluded because of physical or mental inability to fill out the form. 352 of the remaining 493 patients completed the 3 months form and 355 the 12 months form. 127 patients were operated with external fixation or internal fixation due to unstable fractures and the rest were treated conservatively in a cast for four weeks. The patients were subdivided in a non-osteoporotic group, defined as men under the age of 60 and women under the age of 50 and an osteoporotic group above that age. The DASH-form was sent to an age- and gender-matched control group for comparison

Results: The response rate was 72% at both 3 months and 12 months. For the whole group the DASH score decreased from 24 at 3 months to 17 at 12 months (p< 0,001; scale range 0–100). The DASH-score in the younger, non-osteoporotic group was 17 and 12 and for the osteoporotic group 27 and 18 at 3 and 12 months respectively. At one year there was no difference in DASH score between the operated patients and the patients treated conservatively. In the age and gender matched control-group DASH score was 8; in the older group 10 and in the younger 3.

Conclusion: A distal radius fracture has a great impact on the patients function the first year as measured with the validated DASH-score. Three months after fracture patients have markedly increased DASH-score, which decreases slowly for the next nine months but do not normalize as compared to a non-injured matched population. The worst scores are seen in the older population. In our experience operative treatment in the unstable fractures manages to restore function to a level equal to patients with stabile, conservatively treated fractures.