Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis

Abstract

Objective: To make a systematic assessment of the Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Methods: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed. The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected. The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated. RevMan 5.0 was used for data analysis. Results: Sixteen studies involving 1 268 patients were included. There were 618 patients with open reduction and internal fixation and 650 with external fixation. The results of meta-analysis indicated that there were statistically significant differences with regard to the complications postoperatively (infection(I(2)=0%, RR=0.27, 95% CI 0.16-0.45, Z=4.92, P<0.000 01) and total complications(I(2)=0%, RR=0.71, 95% CI 0.59-0.85, Z=3.65, P=0.000 3) ), DASH scores(I(2)=37%, MD=-5.67, 95% CI -8.31--3.04, Z=4.22, P<0.000 1) and volar tilt(I(2)=78%, MD=2.29, 95% CI 0.33-4.24, Z=2.30, P=0.02)(P<0.05) at the end of follow-up period were noted. There were no statistically significant differences observed between two approaches with respect to the clinical outcomes (grip strength, flexion, extension, pronation, supination, radial deviation and ulnar deviation) and radiographic outcome(radial length) at the end of follow-up period(P<0.05). Conclusion: Both open reduction and internal fixation and external fixation are effective treatment for unstable distal radius fractures. Compared with external fixation, open reduction and internal fixation provides reduced complications postoperatively, lower DASH scores and better restoration of volar tilt for treatment of distal radius fractures.