Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of De Palma percutaneous pinning versus bridging external fixation
Open Access
- 29 June 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Musculoskeletal Disorders
- Vol. 11 (1), 137
- https://doi.org/10.1186/1471-2474-11-137
Abstract
Background At present, there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius. This study compared the effectiveness of two methods used in surgical treatment of such fractures: percutaneous pinning and external fixation. Methods We randomly allocated 100 patients into two groups treated surgically with modified De Palma percutaneous pinning and bridging external fixation. Independent but not blinded evaluators administered the DASH quality-of-life questionnaire at postoperative months 6 and 24, performed functional assessment of pain, range of motion, and palm grip strength, and radiographic examinations (volar and radial angle, and height of the radius) before the operation, immediately afterwards, and at 6 and 24 months postoperative. Modified De Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery. Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been randomised according to the intention-to-treat principle. A significance level of 5% (alpha = 0.05). was used for all statistical tests, such that tests presenting a p-value less than 0.05 were considered statistically significant. Results Ninety one (58.8 mean age and 66 participants were female) were included in the final assessment at 24 months. The DASH questionnaire evaluation showed a statistically significant result favouring the De Palma group (mean difference = -7.1 p = 0.044) after six months, but this was not maintained at 24 months. There were no statistically differences between the groups with respect to palm grip strength. Analysis of the range-of-motion limitation index (uninjured side minus affected side motion of) showed a statistical difference (mean difference = 2.4 p = 0.043) favoring the external fixator group with regard to the supination movement 6 months after the operation; however, this was not maintained at 24 months. The final results of the radiographic evaluation were similar for the two groups. Overall, five patients developed complications: two with De Palma pinning and three with external fixation. Conclusion There was a small statistically significant difference favouring the De Palma method in early functional at 6 months according to the DASH questionnaire, and for supination movement favouring the fixator group. However, both were not clinical relevant. By 24 months the groups were similar for all outcomes Trial registration Current Controlled Trials ISRCTN04892785Keywords
This publication has 19 references indexed in Scilit:
- Surgical interventions for treating distal radial fractures in adultsEmergencias, 2009
- A revolution in the management of fractures of the distal radius?The Journal of Bone and Joint Surgery. British volume, 2008
- Are distal radius fracture classifications reproducible? Intra and interobserver agreementSao Paulo Medical Journal, 2008
- Different methods of external fixation for treating distal radial fractures in adultsEmergencias, 2008
- Fractures of the distal radius (Colles' fracture)Sao Paulo Medical Journal, 2007
- Prediction of Instability in Distal Radial FracturesPublished by Ovid Technologies (Wolters Kluwer Health) ,2006
- Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand QuestionnaireBrazilian Journal of Medical and Biological Research, 2005
- External fixation versus percutaneous pinning for unstable Colles' fracture: Equal outcome in a randomized study of 60 patientsActa Orthopaedica, 1997
- Transulnar Percutaneous Pinning of Displaced Distal Radial FracturesJournal of Orthopaedic Trauma, 1989
- The reliability of a linear analogue for evaluating painAnaesthesia, 1976