IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 2 Ver. VIII (Feb. 2015), PP 05-07
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Fracture Fixation of Distal Part of the Radius A Comparative

Study of Different Methods
Dr. william isapure
Abstract:
Background: A variety of treatment modalities are available for fracture of distal radius. However, there is a
lack of consensus on the preferred treatment in these cases.
Aims: To compare the different methods for the treatment fracture of distal part of the radius based on the
outcome at the end of treatment.
Methods: Analysis of cases with fracture of distal radius treated at our centre over a period of seven years. A
total of 301 patients were included in the study and end of treatment outcome was compared based on clinical
appearance of the wrist at discharge, restoration of normal movements of the wrist joint and resumption of
normal activities.
Results: Of the total number of cases admitted for fracture distal radius, nearly 75% cases were operated on
using Percutaneous Fixation with K-wires (n=80), Locking Compression Plate (n=75), and External Fixation
(n=77). It was observed that the clinical appearance of the wrist joint was remarkably better in patients treated
with Locking Compression Plate (93.3%) than Percutaneous Fixation with K-wires and External Fixation.
Better treatment outcome with regard to the restoration of movements of the wrist joint and resumption of
normal activities was noted for patients treated with Locking Compression Plate (96%) than Percutaneous
Fixation with K-wires and External Fixation.
Conclusions: Our study concludes that Locking Compression plate is a better treatment option for fracture of
distal radius than the percutaneous fixation, and external fixation methods.
Keywords: Distal radius fracture, K-wires, Locking Compression Plate, External Fixation

I.

Introduction

Fracture of the distal radius is a common injury of the upper extremity. Fractures of distal radius
usually occur as a result of high-energy trauma in younger individuals [1]. Besides, these fractures are also
reported in elderly osteoporotic patients [2]. A variety of treatment modalities are available for management of
fracture of distal radius. The fracture of the distal radius can be treated conservatively using a plaster cast or by
methods such as external fixation, percutaneous fixation with K-wires or Locking Compression Plate (LCP).
The primary goal of treatment in fractures of distal radius is to obtain anatomical reduction and stable fixation
so as to minimize the risk of post-traumatic arthritis [1]. Though a variety of treatment options are available for
treatment of fracture distal radius, there is a lack of consensus on the preferred treatment modality that needs to
be followed. There is not enough evidence in the published literature to suggest or recommend any specific
treatment for distal radius fractures [3,4].
The present study was conducted with an aim to compare the effectiveness of different treatment
modalities for management of fracture of distal part of the radius based on the treatment outcome.

II.

Materials And Methods

Material of the study consisted of all the patients admitted to our centre for treatment of fracture distal
end of radius. The study was conducted over a period of 7 years and detailed analysis of cases with fracture of
distal radius treated at our centre was carried out. A total of 301 patients were included in the study and end of
treatment outcome was compared based on clinical appearance of the wrist at discharge, restoration of normal
movements of the wrist joint and resumption of normal activities. The details were entered in a data sheet and
analysed and the results obtained are shown in proportions

III.

Results

Over a period of 7 years, a total of 301 patients were treated for fracture distal radius. Of the total
number of cases admitted for fracture distal radius, 24% cases were treated conservatively (Figure 1) while the
others (76%) were treated using Percutaneous Fixation with K-wires (n=80), Locking Compression Plate
(n=75), and External Fixation (n=77). Different procedures were performed on a similar number of cases in each
group. Details of procedures performed on patients treated for the fracture of distal radius over the study period
are shown in Table 1.
DOI: 10.9790/0853-14280507

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Fracture fixation of distal part of the Radius A comparative study of different methods
It was observed that the clinical appearance of the wrist joint was remarkably better in patients treated
with Locking Compression Plate (93.3%) than Percutaneous Fixation with K-wires (65%) and External Fixation
(61%). Better treatment outcome with regard to the restoration of movements of the wrist joint and resumption
of normal activities was noted for patients treated with Locking Compression Plate (96%) than Percutaneous
Fixation with K-wires (56.3%) and External Fixation (32.5%). Details of the clinical appearance of the wrist
joint and restoration of movements of the wrist joint and resumption of normal activities following different
operative procedures for the treatment of distal fracture radius are shown in Table 2 and 3 respectively.

IV.

Discussion

Distal radius fractures are the most common fractures of the upper extremity and constitutes of nearly
one-sixth of all fractures treated in emergency [5]. Treatment for the fracture of distal radius varies from
traditional method of close reduction and immobilization in a plaster cast to less invasive procedures such as
External Fixation and Percutaneous Fixation with K-wires and relatively more complex operative maneuvers of
the fractured bone with Locking Compression Plate. Though the conservative management by close reduction is
a widely used treatment for fracture distal radius, it has been associated with inadequate fixation and loosening
of the reduction [6,7]. Previous studies have observed a high incidence of displacement deformity in plaster cast
treatment [8]. External fixation was thus, considered as one of the better treatment option [2]. Better restoration
of normal wrist anatomy can be achieved by external fixation [9]. The procedure of external fixation is often
accompanied with percutaneous fixation with K-wires to maintain the reduction of articular fragments.
However, these are frequently associated with pin-track infections, loss of reduction, complex regional pain
syndrome and stiffness of joints [10,11]. Open reduction and plate fixation as a treatment for fracture distal
radius has gained popularity over the years. This surgical technique involves either a volar or a dorsal incision.
A combined volar and dorsal approach has also been used in the treatment of fracture distal radius depending on
the extent of displacement and comminution of fracture [1]. In cases of fracture of distal radius, open reduction
and internal fixation with volar T-plate radius locking and unlocking in adults is shown to restore articular
congruity and restore excellent wrist function [5]. Open reduction and plate fixation is often considered as the
treatment of choice for fracture of distal radius especially in comminuted fractures and intra-articular
involvement [12,13].
Our observations based on the comparative analysis of different procedures for the treatment of distal
radius fractures in the present study, suggest that clinical appearance of the wrist joint was remarkably better
due to restoration of wrist anatomy in patients treated with Locking Compression Plate. Clinical outcome in
regard to clinical appearance of the wrist joint was similar in patients treated with Percutaneous Fixation with Kwires and External Fixation. In the present study, treatment with Locking Compression Plate showed excellent
results with regard to the early restoration of wrist function and movements of the wrist joint that was related to
the early resumption of routine activities. Treatment with Percutaneous Fixation with K-wires showed a
moderate result while maximum delay in restoration of wrist joint function was noted for patients treated by
External Fixation. Our study findings thus are in support of the views presented in earlier studies [1] that open
reduction and plate fixation is a better treatment for distal radius fractures than external fixation and
percutaneous fixation. Contrary to our observations, a study by Kreder et al. [14] observed that indirect
reduction and percutaneous fixation were associated with a better functional outcome than with open reduction
and internal fixation. Differences in the treatment outcome between different treatment modalities in various
studies can be attributed to the differences in extent of fractures with articular surface involvement included in
the studies and based on techniques applied in treatment.

V.

Conclusions

The present study concludes that Locking Compression Plate is better treatment option for fracture of
distal radius than the percutaneous fixation, and external fixation methods. Our observations are based on the
clinical appearance of the wrist at discharge, restoration of normal movements of the wrist joint and resumption
of normal activities. Better treatment outcome with Locking Compression Plate can be ascribed to proper
reduction and rigid fixation, and early mobilization following this procedure and to the absence of pin track
infections and post-operative immobilizations.

References
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[2].
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Leung F, Tu YK, Chew WY, Chow SP. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular
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Moroni A, Vannini F, Faldini C, Pegreffi F, Giannini S. Cast vs external fixation: a comparative study in elderly osteoporotic distal
radial fracture patients. Scand J Surg. 2004;93(1):64-7.
Lozano-Caldern SA, Doornberg JN, Ring D. Retrospective Comparison of Percutaneous Fixation and Volar Internal Fixation of
Distal Radius Fractures. Hand 2008;3:102110.
Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev
2003;(3):CD003209.

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Fracture fixation of distal part of the Radius A comparative study of different methods
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Res 1990;254:236241.
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Table 1: Treatment details of the patients treated for fracture of distal radius over the study period
Year
2005
2006
2007
2008
2009
2010
2011
2012
Total

Percutaneous Fixation
with K-wires
5
8
6
11
6
15
6
23
80

Locking Compression
Plate (LCP)
7
9
9
12
10
11
14
3
75

External
Fixation
6
13
5
21
4
4
13
17
77

Total Operated
Patients
18
30
20
44
20
30
33
37
232

Table 2: Clinical appearance of the wrist joint after treatment

Procedure
Locking Compression Plate (LCP)
Percutaneous Fixation with K-wires
External Fixation

Number
of patients
75 (100%)
80 (100%)
77 (100%)

Better restoration and

wrist appearance
70 (93.3%)
52 (65%)
47 (61%)

Poor restoration and

wrist appearance
5 (6.7%)
28 (35%)
30 (39%)

Table 3: Restoration of movements of the wrist joint and resumption of normal activities
Procedure
Locking Compression Plate (LCP)
Percutaneous Fixation with K-wires
External Fixation

Number of patients
75 (100%)
80 (100%)
77 (100%)

Early resumption
72 (96%)
45 (56.3%)
25 (32.5%)

Late resumption
3 (4%)
35 (43.7%)
52 (67.5%)

Figure 1: Distribution of operated and non-operated patients during the study period

DOI: 10.9790/0853-14280507

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