Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial

J Bone Joint Surg Br. 2008 Sep;90(9):1214-21. doi: 10.1302/0301-620X.90B9.20521.


We performed a prospective, randomised trial to evaluate the outcome after surgery of displaced, unstable fractures of the distal radius. A total of 280 consecutive patients were enrolled in a prospective database and 88 identified who met the inclusion criteria for surgery. They were randomised to receive either bridging external fixation with supplementary Kirschner-wire fixation or volar-locked plating with screws. Both groups were similar in terms of age, gender, hand dominance, fracture pattern, socio-economic status and medical co-morbidities. Although the patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist, this advantage diminished with time and in absolute terms the difference in range of movement was clinically unimportant. Radiologically, there were no clinically significant differences in the reductions, although more patients with AO/OTA (Orthopaedic Trauma Association) type C fractures were allocated to the external fixation group. The function at one year was similar in the two groups. No clear advantage could be demonstrated with either treatment but fewer re-operations were required in the external fixation group.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Plates
  • Bone Wires
  • External Fixators
  • Female
  • Fracture Fixation / instrumentation
  • Fracture Fixation / methods*
  • Fractures, Comminuted / diagnostic imaging
  • Fractures, Comminuted / physiopathology
  • Fractures, Comminuted / surgery*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Radiography
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / physiopathology
  • Radius Fractures / surgery*
  • Range of Motion, Articular
  • Reoperation
  • Treatment Outcome
  • Wrist Joint / diagnostic imaging
  • Wrist Joint / physiopathology
  • Wrist Joint / surgery*