Bridging and non‐bridging external fixation in the treatment of unstable fractures of the distal radius: A retrospective study of 588 patients

Figures & data

Table 1.  Summary of demographic data

	Total (%)	Bridging (%)	Non‐bridging (%)	P‐value
Fractures	588 (100)	230 (39)	358 (61)
AO classification
AO A3.2	224 (38)	31 (13)	193 (54)	< 0.001
AOC2.1	167 (28)	62 (27)	105 (29)
AO C3.2	112 (19)	100 (43)	12 (3)
Other	85 (15)	37 (16)	48 (13)
Open fracture	46 (8)	23 (10)	23 (6)	0.2
Gender
Male	118 (20)	71 (31)	47 (13)	< 0.001
Female	470 (80)	159 (69)	311 (87)
Operating surgeon
Consultant	114(19)	36(16)	78 (22)	0.08
Trainee	474(81)	194(84)	280 (78)
Resulting from fall	441 (75)	152(66)	289(81)	< 0.001
Average age (years)
Overall	61	58	64	< 0.001
Male	47	42	53	0.005
Female	65	65	65	0.1
Duration of fixation (days)	40	41	39	0.07

Table 2.  Results of radiographic measurements of distal radius fractures at four stages of treatment. Values shown are mean for dorsal angle and shortening, and percentage for carpal alignment. The p-values for final outcomes are shown both unadjusted and adjusted for all the factors in Table 1, and also for initial levels of each of the three radiographic measurements. Numbers in parentheses are 95% confidence limits for mean difference or odds ratio for bridging as compared to non-bridging

	Bridging	Non‐bridging	Unadjusted p‐value	Adjusted p‐value
Dorsal angle (°)
Postoperative	−0.3	−5.5	< 0.001
Final	1.5	−6.6	< 0.001	< 0.001 (5.5–9.9)
Shortening
Initial	4	5.3	< 0.001
Preoperative	3.5	2.8	0.02
Postoperative	1.5	0.8	< 0.001
Final	2.8	1.6	< 0.001	< 0.001 (0.3–1.3)
Carpal alignment (%)
Initial	12	4.4	0.004
Preoperative	20	11	0.06
Postoperative	87	90	0.4
Final	63	84	< 0.001	< 0.001 (0.18–0.55)

Table 3.  Complications of distal radius fractures

Complications	Total	Bridging (%)	Non‐bridging (%)	P‐value
Overall	226	75 (33)	151 (42)	0.03
PTI (minor)	126	30(13)	96 (27)	< 0.001
PTI (major)	12	4(2)	8(2)	0.9
Carpal tunnel syndrome	25	11(5)	14(4)	0.8
CRPS	37	16(7)	21 (6)	0.7
EPL rupture	8	1 (0.4)	7(2)	0.2
Failure of external fixation	11	2 (0.9)	9(3)	0.3
Radial nerve injury	8	3(1)	5(1)	1
Ulnar neuropraxia	7	4(2)	3 (0.8)	0.6
Metacarpal fracture	3	3(1)	0(0)	0.1
Delayed union	3	1 (0.4)	2 (0.6)	1
Athrodesis	2	2 (0.9)	0(0)	0.3
Compartment syndrome	5	3(1)	2 (0.6)	0.6
Dorsal malunion	66	50 (24)	16(5)	< 0.001
Volar malunion	26	8(4)	18(5)	0.6
Shortening > 3 mm	219	112(54)	107(32)	< 0.001
PTI: pin-track infection;
CRPS: complex regional pain syndrome;
EPL: extensor pollicis longus.

Table 4.  Odds ratios (95% confidence limits) for outcomes in bridging as compared to non-bridging patients after adjustment for possible confounding factors

	Odds ratio	>P‐value
Carpal tunnel syndrome	0.8 (0.2–2.7)	0.7
CRPS	1.0(0.4–2.5)	1
Minor PTI	0.3 (0.2–0.6)	< 0.001
Volar malunion	0.7 (0.2–2.5)	0.6
Dorsal malunion	6.2(3–13)	< 0.001
Shortening > 3 mm	2.5(1.5–4)	< 0.001