Functional and radiological outcomes in distal radius fractures treated with a volar plate vs. an external fixator

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Purpose To compare the functional and radiological results obtained in distal radius intraarticular fractures treated by means of internal fixation with a volar buttress plate vs. those treated with an external fixator. Materials and methods We performed a comparative retrospective study of two patient series: 36 distal radius fractures treated with a volar AO T 2.4/2.7 buttress plate and 40 fractures treated with Pennig's dynamic external fixator. We used Müller's AO-ASIF classification following the anteroposterior and lateral x-ray study. We collected data about patient characteristics, mechanism of injury and postoperative complications. Minimum follow-up was 10 months. We performed clinical and radiographic evaluations at the beginning, at 3 months and at the end of follow-up. We used Lidström's scale for the functional assessment. Results In the group treated with a volar buttress plate better results were obtained for ulnar inclination of the radius and volar inclination on the sagittal plane. In this group only one case was left with an intraarticular step-off greater than or equal to 3 mm, as compared with 6 cases in the group treated with external fixation. 80% of patients treated with a volar plate obtained excellent or good results on the Lidström scale, as compared with 72.5% in the external fixation group, there being no statistically significant differences between the two groups. 30% of patients treated with an external fixator developed complications during follow-up, as compared with 22.2% in the volar plate group. OR time in the volar plate group was 74 minutes on average, whereas in the external fixation group it was 42 minutes. Mean time to postoperative mobilization was 12 days in the volar plate group. In patients treated with external fixation, the fixator was dynamized at 40 days on average and withdrawn at 62 days on average. Conclusions Our study shows that both kinds of treatment seem to afford similar radiological and functional results. Direct reduction followed by volar buttress plate fixation seems to provide for a more stable sort of anatomical reduction. Nevertheless, such difference does not lead to better functional outcomes. Both methods of treatment present with an acceptable postoperative complications rate.