Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis

Our aim was to compare the effect of internal vs external fixation for unstable distal radius fractures regarding postoperative complications, clinical results and radiological outcomes.

We selected PubMed; Cochrane Library; EMBASE; BIOSIS; Ovid and the relevant English orthopaedic journals and pooled data from ten eligible randomised controlled trials containing 738 patients to conduct a subgroup analysis according to different periods of follow-up. Our aim was to summarise the best available evidence.

Results showed that compared with external fixation, internal fixation led to significantly fewer total surgical complications [95% confidence interval (CI) 0.39–0.81, P = 0.002] and reduced the incidence of pin-track infections (95% CI 0.08–0.46, P = 0.0002) after a one year follow-up. For clinical results, grip strength (95% CI 1.59–8.25, P = 0.004), supination (95% CI 13.99–48.83, P = 0.0004) and pronation (95% CI 5.61–26.09, P = 0.002) were superior in the internal fixation group six weeks postoperatively, and the same results were obtained three months postoperatively for grip strength (95% CI 3.21–13.47, P = 0.001) and supination (95% CI 3.61–16.01, P = 0.002). Meanwhile, the Disabilities of the Arm, Shoulder and Hand (DASH) score was superior in the internal fixation group at three months (95% CI −20.62 to −2.07, P = 0.02) and after one year (95% CI −14.37 to −2.32, P = 0.007) follow-up.

We suggest that the final results are significant and there is some evidence supporting the use of open reduction and internal fixation.