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Acta Orthop. Aug 7, 2009; 80(4): 478–485.
Published online Aug 1, 2009. doi:  10.3109/17453670903171875
PMCID: PMC2823185
Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures
A randomized study of 50 patients
Antonio Abramo,corresponding author1 Philippe Kopylov,1 Mats Geijer,2 and Magnus Tägil1
1Hand Unit, Department of Orthopedics, Clinical Sciences, Lund University, , Sweden
2Department of Radiology, Lund University Hospital, , Sweden
corresponding authorCorresponding author.
Correspondence: tony.abramo/at/med.lu.se
Received April 22, 2008; Accepted February 22, 2009.
Abstract
Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation.
Methods 50 patients with an unstable or comminute distal radius fracture were randomized to either closed reduction and bridging external fixation, or open reduction and internal fixation using the TriMed system. The primary outcome parameter was grip strength, but the patients were followed for 1 year with objective clinical assessment, subjective outcome using DASH, and radiographic examination.
Results At 1 year postoperatively, grip strength was 90% (SD 16) of the uninjured side in the internal fixation group and 78% (17) in the external fixation group. Pronation/supination was 150° (15) in the internal fixation group and 136° (20) in the external fixation group at 1 year. There were no differences in DASH scores or in radiographic parameters. 5 patients in the external fixation group were reoperated due to malunion, as compared to 1 in the internal fixation group. 7 other cases were classified as radiographic malunion: 5 in the external fixation group and 2 in the internal fixation group.
Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year, and tended to have less malunions than external fixation. No difference could be found regarding subjective outcome.
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