The preferability of internal fixation in comparison to external fixation in geriatric patients after distal radial fracture in terms of functional and clinical outcomes – a systematic review
DOI:
https://doi.org/10.12775/QS.2024.22.54528Keywords
geriatric, external fixation, internal fixation, distal radial fractureAbstract
Background: Distal radial fractures (DRFs) are common in the elderly, particularly among those over 65, due to factors such as osteoporosis, falls, and comorbidities. Treatment options, including external fixation (ExFix) and internal fixation (IF) with volar locking plates (VLPs), offer different benefits and drawbacks, making the optimal approach for elderly patients a topic of ongoing debate.
Objective: This systematic review aims to evaluate the effectiveness and safety of different treatment modalities for DRFs in elderly patients, focusing on functional outcomes, radiographic parameters, and complication rates.
Methods: A comprehensive search was conducted on PubMed, focusing on studies comparing ExFix and IF in elderly patients. Studies were screened based on predefined inclusion criteria, and data on functional outcomes, radiographic alignment, and complications were extracted and analyzed.
Results: Two studies met the inclusion criteria. Huang et al. demonstrated that VLPs offered better functional outcomes, with improved supination and fewer complications, compared to ExFix. In contrast, the systematic review by Diaz-Garcia et al. suggested that while VLPs generally provided good outcomes, Non-Bridging External Fixation (Non-BrEF) showed superior grip strength in some analyses. Radiographic outcomes varied, with VLPs typically providing better volar tilt and radial inclination, though the clinical significance of these differences remains uncertain. Complication rates were lower with VLPs in Huang et al.'s study, but Diaz-Garcia et al. noted a higher incidence of major complications requiring surgery with VLPs.
Conclusion: The findings suggest that VLPs may offer superior functional outcomes and lower complication rates compared to ExFix in elderly patients with DRFs. However, further research is needed to clarify the clinical significance of these differences and optimize treatment strategies for this vulnerable population.
References
References
Jerrhag D, Englund M, Karlsson MK, Rosengren BE. Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord. 2017;18(1):240. Published 2017 Jun 2. doi:10.1186/s12891-017-1596-z
Corsino CB, Reeves RA, Sieg RN. Distal Radius Fractures. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536916/
Court-Brown CM , Caesar B . Epidemiology of adult fractures: a review. Injury 2006; 37:691–697 .
Vogt MT, Cauley JA, Tomaino MM, Stone K, Williams JR, Herndon JH. Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures. J Am Geriatr Soc. 2002 Jan;50(1):97-103.
Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014 Oct-Dec;3(4):325-32. doi: 10.4103/2249-4863.148101. PMID: 25657938; PMCID: PMC4311337.
Court-Brown CM , Clement ND , Duckworth AD , Biant LC , McQueen MM . The changing epidemiology of fall-related fractures in adults. Injury 2017; 48:819–824 .
Chung KC, Cho HE, Kim Y, Kim HM, Shauver MJ; WRIST Group. Assessment of anatomic restoration of distal radius fractures among older adults: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2020;3(1):e1919433-e1919433. doi:10.1001/jamanetworkopen.2019.19433
Chung KC, Kim HM, Malay S, Shauver MJ; Wrist and Radius Injury Surgical Trial Group. The wrist and radius injury surgical trial: 12-month outcomes from a multicenter international randomized clinical trial. Plast Reconstr Surg. 2020;145(6):1054e-1066e. doi:10.1097/PRS.0000000000006829
Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-125. doi:10.1016/j.hcl.2012.02.001
Jayaram M, Wu H, Yoon AP, Kane RL, Wang L, Chung KC. Comparison of Distal Radius Fracture Outcomes in Older Adults Stratified by Chronologic vs Physiologic Age Managed With Casting vs Surgery. JAMA Netw Open. 2023;6(2):e2255786. doi:10.1001/jamanetworkopen.2022.55786
Gennaro P, Bartolozzi P, Bigazzi P, et al. External fixation of distal radial fractures. Clin Orthop Relat Res. 1986;208:182-185. ???
American Academy of Orthopaedic Surgeons. Management of Distal Radius Fractures: Evidence-Based Clinical Practice Guideline. Accessed from: https://www.aaos.org/globalassets/quality-and-practice-resources/distal-radius/drfcpg.pdf
Fragomen AT, Rozbruch SR. The mechanics of external fixation. HSS J. 2007 Feb;3(1):13-29. doi: 10.1007/s11420-006-9025-0. PMID: 18751766; PMCID: PMC2504087.
Tabish, Tahir., Qazi, Waris, Manzoor., Shamim, Ahmad, Bhat., Khurshid, Anmad, Kangoo. Functional outcome of external fixators in unstable distal radius fractures. International Journal of Orthopaedics Sciences, (2018).;4(2):869-874. doi: 10.22271/ORTHO.2018.V4.I2M.125
Shields DW, Iliadis AD, Kelly E, Heidari N, Jamal B. Pin-site Infection: A Systematic Review of Prevention Strategies. Strategies Trauma Limb Reconstr. 2022;17(2):93-104. doi:10.5005/jp-journals-10080-1562
Mohammadreza, Safdari., Mahmoodreza, Mohajer, Koohestani. Comparing the effect of volar plate fixators and external fixators on outcome of patients with intra-articular distal radius fractures: A clinical trial.. Electronic physician, (2015).;7(2):1085-1091. doi: 10.14661/2015.1085-1091
Hadeed A, Werntz RL, Varacallo M. External Fixation Principles and Overview. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 4, 2023.
Lowe J. Internal Fixation for Fractures - OrthoInfo - AAOS. www.orthoinfo.org. Published April 2019. https://orthoinfo.aaos.org/en/treatment/internal-fixation-for-fractures/
Bartl C, Stengel D, Bruckner T, Gebhard F; ORCHID Study Group. The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arztebl Int. 2014;111(46):779-787. doi:10.3238/arztebl.2014.0779
Yuan ZZ, Yang Z, Liu Q, Liu YM. Complications following open reduction and internal fixation versus external fixation in treating unstable distal radius fractures: Grading the evidence through a meta-analysis. Orthopaedics & Traumatology: Surgery & Research. 2018;104(1):95-103. doi:https://doi.org/10.1016/j.otsr.2017.08.020
Nasser JS, Huetteman HE, Shauver MJ, Chung KC. Older Patient Preferences for Internal Fixation after a Distal Radius Fracture: A Qualitative Study from the Wrist and Radius Injury Surgical Trial. Plast Reconstr Surg. 2018;142(1):34e-41e. doi:10.1097/PRS.0000000000004454
Ali Fazal M, Denis Mitchell C, Ashwood N. Volar locking plate: Age related outcomes and complications. J Clin Orthop Trauma. 2020;11(4):642-645. doi:10.1016/j.jcot.2020.05.025
Lutsky K, Boyer M, Goldfarb C. Dorsal locked plate fixation of distal radius fractures. J Hand Surg Am. 2013;38(7):1414-1422. doi:10.1016/j.jhsa.2013.04.019
Rancy SK, Malliaris SD, Bogner EA, Wolfe SW. Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant. J Wrist Surg. 2018;7(5):358-365. doi:10.1055/s-0038-1669438
Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am. 2011;93(4):328-335. doi:10.2106/JBJS.J.00193
Chitnis AS, Vanderkarr M, Sparks C, McGlohorn J, Holy CE. Complications and its impact in patients with closed and open tibial shaft fractures requiring open reduction and internal fixation. Journal of Comparative Effectiveness Research. 2019;8(16):1405-1416. doi:https://doi.org/10.2217/cer-2019-0108
Obert L, Loisel F, Gasse N, Lepage D. Distal radius anatomy applied to the treatment of wrist fractures by plate: a review of recent literature. SICOT-J. 1. doi:https://doi.org/10.1051/sicotj/2015012
Summers K, Fowles SM. Colles’ Fracture. PubMed. Published 2022. Accessed October 25, 2022. https://www.ncbi.nlm.nih.gov/books/NBK553071/#:~:text=Colles%20fractures%20are%20one%20of
Schroeder JD, Varacallo M. Smith’s Fracture Review. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK547714/
Huang YY, Lin TY, Chen CH, Chou YC, Su CY. Surgical outcomes of elderly patients aged more than 80 years with distal radius fracture: comparison of external fixation and locking plate. BMC Musculoskelet Disord. 2020;21(1):91. Published 2020 Feb 10. doi:10.1186/s12891-020-3101-3
Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A Systematic Review of Outcomes and Complications of Treating Unstable Distal Radius Fractures in the Elderly. The Journal of Hand Surgery. 2011;36(5):824-835.e2. doi:https://doi.org/10.1016/j.jhsa.2011.02.005
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Kuba Kupniewski, Kornelia Krawczyk, Karolina Majka, Helena Perenc, Karolina Pasieka, Urszula Korzonek, Paulina Kosiorowska, Michał Kosar, Marek Pędras
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 203
Number of citations: 0
