External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes

J Orthop Traumatol. 2014 Dec;15(4):265-70. doi: 10.1007/s10195-014-0317-8. Epub 2014 Sep 6.


Background: The objective of the study was to compare the efficacy of external fixation and volar plating on the functional parameter of displaced intra-articular (Cooney's type IV) distal end radius fractures using the Green and O'Brien scoring system.

Materials and methods: This prospective randomized study comprised 68 patients treated with external fixation and 42 patients treated with volar locking plates. The patients were followed up at 6 months and 1 year after surgery. The assessment of pain, range of motion, grip strength and activity were assessed at each follow-up visit and scored according to the Green and O'Brien scoring system.

Results: At 1 year after surgery, we observed that external fixation showed significantly better results than volar locking plates using the Green and O'Brien scores for range of motion (22.0 ± 4.77 vs 19.89 ± 5.05), grip strength (19.91 ± 5.4 vs 16.89 ± 4.4) and final outcome (87.36 ± 11.62 vs 81.55 ± 11.32). No difference was found in pain and activity between these two groups of patients. Patients aged <50 years treated with external fixation showed excellent results (final score (91.57 ± 9.01) at 1 year follow-up.

Conclusion: External fixation showed superiority over volar locked plating after 1 year of surgery.

Level of evidence: IV.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Bone Plates*
  • External Fixators*
  • Female
  • Fracture Fixation, Internal / instrumentation*
  • Fracture Fixation, Internal / methods
  • Fracture Healing / physiology
  • Humans
  • Injury Severity Score
  • Intra-Articular Fractures / diagnostic imaging
  • Intra-Articular Fractures / surgery*
  • Male
  • Middle Aged
  • Prospective Studies
  • Radiography
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / surgery*
  • Range of Motion, Articular / physiology
  • Recovery of Function
  • Risk Assessment
  • Tensile Strength
  • Treatment Outcome
  • Wrist Injuries / diagnostic imaging
  • Wrist Injuries / surgery