Internal vs. External Fixation for the Treatment of Closed Unstable Distal Radial Fractures in elderly: A Meta- Analysis of Clinical Trials

Gong Z, Wu Y, Hu Z, Li X and Mao Q

Department of Orthopedics, Taishun People's Hospital, China

^*Correspondance to: Zhifeng Gong 

 PDF  Full Text DOI: 10.25107/2474-1647.3683

Abstract

Background: Distal Radial Fractures (DRFs) in the elderly are common, and Open Reduction and Internal Fixation (ORIF) and External Fixation (EF) are the two main treatments. Our primary aim was to assess the clinical effectiveness of the two interventions in the elderly (≥ 65 years). Methods: We performed a comprehensive search of PubMed, EMBASE and the Cochrane Library until February 31st, 2022. Studies were included if they investigated internal and external fixation for distal radial fractures in the elderly. The primary outcomes were Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) score, grip strength and complications, and secondary outcomes were functional and radiological assessments. Data were synthesized, and weighted mean difference with 95% Confidence Interval (CI) were calculated. Results: Nine studies with a total of 569 patients in internal fixation groups and 576 patients in external fixation groups were included in the analysis. There were no significant differences in DASH score, PRWE score, grip strength, and incidence of total complications. No significant differences in functional assessment (including extension, flexion, pronation, supination, radial deviation, and ulnar deviation) were noted between two groups. As to radiological assessment, ORIF yielded significant better radial height, radial inclination and volar tilt, and less radial variance than patients in the EF group. Conclusion: ORIF and EF produce similar results in the treatment of DRFs in the elderly, and minor objective radiological assessment did not result an impact on subjective function outcomes. These findings indicate that EF treatment might be more suitable for the treatment of DRFs in the elderly with respect to reducing postoperative complications and economic burden into medical cost.

Keywords

Distal radial fractures; Open reduction and internal fixation; External fixation; Elderly

Cite the article

Gong Z, Wu Y, Hu Z, Li X, Mao Q. Internal vs. External Fixation for the Treatment of Closed Unstable Distal Radial Fractures in elderly: A Meta- Analysis of Clinical Trials. Clin Surg. 2024; 9: 3683..