External fixation versus closed treatment of displaced distal radial fractures in elderly patients: a randomized controlled trial

Hypothesis Acutely applied external fixation in patients, 60-85 years of age, with displaced low-energy trauma fractures results in a better outcome than traditional plaster cast treatment. Methods Fifty-nine patients (53 women and six men), 60-85 years of age, with displaced fractures were prospectively randomized to closed reduction and plaster casting or primary external fixation. Fifty-one patients were followed for 1 year with repeated radiographic examinations, registrations of wrist mobility, grip strength, visual analog scale and the Green and O'Brien-Cooney Score. Twenty-seven patients had extra-articular fractures (six AO Class A2, 21 A3) and 24 had intra-articular fractures (one AO Class C1 and 15 C2 and eight C3). Results No significant differences in clinical outcome, visual analog scale, grip strength or wrist mobility were found between the groups. At 1 year, 17 of 22 (77%) were classified as satisfactory in the external fixation group and 23 of 29 (79%) in the plaster group. Grip strength was 75% of normal at 1 year. Pain or impaired hand function during heavier work and reduced hand strength were the main sequels. One third of the patients in the external fixation group suffered complications. Radiographically, the external fixation group had better anatomy regarding dorsal angulation (11 degrees compared to 20 degrees) and radial inclination angle (23 degrees compared to 16 degrees) but not radial shortening. Six patients in the external fixation and eight in the plaster-treated group developed mild osteoarthritis. Conclusions Primary external fixation of displaced distal radial fractures in 60-85 year old patients had a positive effect on the radiographic result but did not have any clinical benefits compared to cast treatment.