Comparison of internal and external fixation of distal radius fractures

Figures & data

Figure 1. Flow chart of the meta-analysis.

Table 1. Basal characteristics of clinical trials included in the analysis

Author Year	Age	No. of fract. (EF/IF)	Femal (EF/IF)	Classification of fractures	IF	EF	Follow-up (months)	Outcomes measured	Jadad score
Grewal et al. 2011	18–75	26 /27	18/20	AO type A, C1, C2, C3	Volar locking plates and dorsal Pi plates	Bridging fixators + suppl. K-wires	12	PRWE and DASH scores, grip strength, ROM, radiographic results and complications.	3
Wilcke et al. 2011	20–70	30 /33	23/25	AO type A, C1	Volar locking plates	Bridging fixators ± suppl. K-wires	12	PRWE and DASH scores, grip strength, ROM, radiographic results and complications.	3
Wei et al. 2009	>18	22/12	16/8	AO type A3, C1, C2, C3	Locked radial column plates and volar locking plates	Bridging fixators + suppl. K-wires	12	DASH score, grip and lateral pinch strength, ROM, pain scores, radiographic results and complications.	4
Abramo et al. 2009	20–65	24/26	17/19	AO type A1–3, C1–3	The TriMed system	Bridging fixators + suppl. K-wires	12	DASH score, grip strength, ROM, pain scores, radiographic results and complications.	3
Xu et al. 2009	21–56	14/16	5/7	AO type C	A variety of non-locking plates.	Bridging fixators ± suppl. K-wires	24	The Green and O’Brien scoring, grip strength, ROM, radiographic results and domplications.	2
Egol et al. 2008	18–87	44/44	22/25	AO type A, B, C	Volar locking plates	Bridging fixators ± suppl. K-wires	12	DASH score, grip strength, ROM, radiographic results and complications.	3
Leung et al. 2008	17–60	74/70	—	AO type C1, C2, C3	Nonlocking T-plates, combined volar and dorsal plate fixation ^a	Bridging fixators ± suppl. K-wires	24	Gartland and Werley point system, Green and O’Brien clinical score, arthritis grade, daily activities, social activities, interference of normal work and complications.	3
Grewal et al. 2005	<70	33/29	12/17	AO type C	Locked dorsal Pi plate	Bridging fixators + suppl. K-wires	24	DASH scores, SF36 scores, grip and pinch strength, ROM, radiographic results, surgical outcomes and complications.	2
Kreder et al. 2005	16–75	88/91	38/32	AO type B, C	Small or mini-fragment plate	Bridging fixators ± suppl. K-wires	24	MFA function test, SF36 scores, Jebsen score, grip strength and pinch strength, three-jaw chuck and pad-to-pad pinch strength, ROM, radiographic results and complications.	3
Kapoor et al. 2000	—	28/29	8/10	Frykman’s type III, IV, VII, VIII	Small T plates	Bridging fixators	48	Grip strength, radiographic results, Sarmiento functional score and complications.	1

^a The latter was done for more comminuted fractures

PRWE: Patient Rated Wrist Evaluation.

DASH: Disabilities of the Arm, Shoulder, and Hand.

ROM: Range of motion.

Figure 2. Comparison of the effects of internal and external fixation on DASH score at 12 months after surgery. (

) The weighting given to the trial in the overall pooled estimate, taking into account the number of participants and the amount of between-study variation (heterogeneity). (

) The combined effect size.

Table 3. Comparison of internal fixation (IF) using volar locking plates and external fixation (EF) regarding the outcomes of DASH, grip strength, and 12-month radiological results

			Fractures
Time	Time or parameters	Studies	EF	IF	Weighted mean difference	95% CI	p-value	Favored
DASH	3 months	4	112	102	14.3	7 to 22	< 0.001	IF
	6 months	4	113	102	6.2	3 to 9	< 0.001	IF
	12 months	4	113	102	6.1	-0.7 to 13	0.08
Grip strength	3 months	3	90	84	-14	-25 to -3	0.01	IF
	6 months	3	90	84	3.1	-18 to 24	0.8
	12 months	3	90	84	-1.8	-16 to 12	0.8
12-month	Volar tilt	2	60	63	-4.7	-7 to -2	< 0.001	IF
radiological	Radial length	2	60	63	1.0	0.1 to 2	0.03	EF
results	Radial inclination	3	90	96	1.0	-1 to 4	0.4
	Ulnar variance	3	90	96	-0.1	-2 to 2	1

95% CI, 95% confidence interval;

DASH: Disabilities of the Arm, Shoulder, and Hand.

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