External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials.

Background: Both external fixation and open reduction with internal fixation (ORIF) using plates have been recommended for treatment of distal radius fractures. We conducted a systematic review and meta-analysis of randomised controlled trials comparing external fixation to ORIF.

Methods: MEDLINE, EMBASE, and COCHRANE databases were searched from inception to January 2011 for all trials involving use of external fixation and ORIF for distal radius fractures. Eligibility for inclusion in the review was: use of random allocation of treatments; treatment arm receiving external fixation; and treatment arm receiving ORIF with plate fixation. Eligible studies were obtained and read in full by two co-authors who then independently applied the Checklist to Evaluate a Report of a Nonpharmacological Trial. Pooled mean differences were calculated for the following continuous outcomes: wrist range of motion; radiographic parameters; grip strength; and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Pooled risk ratios were calculated for rates of complications and reoperation.

Results: The literature search strategy identified 52 potential publications of which nine publications (10 studies) met inclusion criteria. Pooled mean difference for DASH scores was significantly less for the ORIF with plate fixation group (-5.92, 95% C.I. of -9.89 to -1.96, p < 0.01, I(2) = 39%). Pooled mean difference for ulnar variance was significantly less in the ORIF with plate fixation group (-0.70, 95% C.I. of -1.20 to -0.19, p < 0.01, I(2) = 0%), indicating better restoration of radial length for this group. Pooled risk ratio for infection was 0.37 (95% C.I. of 0.19-0.73, p < 0.01, I(2) = 0%), favouring ORIF with plate fixation. There were no significant differences in all other clinical outcomes.

Conclusions: ORIF with plate fixation provides lower DASH scores, better restoration of radial length and reduced infection rates as compared to external fixation for treatment of distal radius fractures.