Dynamic Compared with Static External Fixation of Unstable Fractures of the Distal Part of the Radius
A Prospective, Randomized Multicenter Study
Distal radial fractures can be treated by a number of different methods of fixation. External fixation is an established method for treating distal radial fractures.
Authors of this study designed an external fixation device (DYNAWRIST; Medinor, Oslo, Norway) applying the principle of dynamic traction. The DYNAWRIST is a flexible distracter, allowing continuous dynamic traction to be applied to the fracture site.
The device was tested in Norway and had also been used for the treatment of several hundred distal radial fractures and in daily use at several hospitals in Norway.
70 consecutive patients with unstable fractures of the distal part of the wrist were randomised into two groups - either into the external dynamic fixation or to external fixation with a static, bridging device.
This study looked to compare the dynamic distracter with current static bridging external factors in terms of anatomical and functional results.
The external fixation frames were kept in place for a mean of six weeks. All patients were clinically and radiographically assessed at the time of removal of the fixator and at three, six and twelve months.
The group of patients that underwent dynamic fixation were allowed to begin multi-directional movement on the first post-operative day.
Results of this study showed dynamic fixation restored radial length significantly better than static fixation. Radial tilt and radial inclination had no differences amongst the two groups.
In the dynamic fixator group, wrist flexion radial deviation, and pronation-supination were regained significantly faster in the dynamic fixator group.
In comparison with the static fixator group, wrist extension was significantly greater in the dynamic fixator group.
The DASH (Disabilities of the Arm, Shoulder and Hand) score and visual analogue pain score were conducted on patients as a self-evaluation measure and demonstrated no significant differences between the two groups.
In the dynamic group, superficial pin-track infections were significantly more common than in the static fixator group.
For the treatment of unstable fractures in the distal part of the radius, continuous dynamic traction with a dynamic external fixator compares favourably with the use of static external fixators.
Mr Mike Hayton's method of fixation for an unstable distal radial fracture is through open surgery using a modern generation volar locking plate. This allows immediate movement of the wrist.