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Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures

      Highlights

      • EF and BP have been proposed as better alternatives to volar plating in comminuted distal radial fractures.
      • EF is associated with pin-related complications, scarring of the extensor mechanism, and injury to the superficial sensory branch of the radial nerve.
      • The BP is kept entirely deep to the skin, thereby avoiding pin track complications, but the main disadvantage of BP is the need for a second surgery to remove the plate.
      • In comparison to external fixation, bridge plating may provide earlier functional recovery with lower complication rates.
      • No functional or radiological superiority of either device were demonstrated at 12-months follow-up.

      Abstract

      Introduction

      Distal radius fractures are the most frequent upper limb injuries encountered by orthopedic surgeons. Surgical treatment of distal radius fractures is preserved for unstable and displaced fractures. A randomized controlled trial was conducted to compare the radiological and functional outcomes of bridge plating (BP) to external fixation (EF) in comminuted intra-articular distal radius fractures.

      Methods

      Sixty patients with distal radius fractures were eligible for treatment by means of ligamentotaxis using either a dorsal bridge plate (30 patients) or an external fixator (30 patients) with or without supplementary Kirschner wires (K-wires). Radiological evaluation was done using the radial inclination angle, radial length, and the volar tilt. Clinical evaluation was performed using ranges of wrist motion, grip strength, Visual Analogue Scale (VAS), and a validated Arabic version of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire

      Results

      Patients were followed up for 12 months. No significant difference was found in terms of radiographic parameters or ranges of wrist motion. At 3-months follow-up, bridge plating group had stronger grip strength, lower Disability of the Arm, Shoulder, and Hand scores, and lower Visual Analogue Scale. However, both groups had similar functional outcomes at last follow-up. External fixation group had a higher rate of postoperative complications.

      Conclusion

      In comparison to external fixation, bridge plating may provide earlier functional recovery with lower complication rates. However, no functional or radiological superiority were demonstrated at 12-months follow-up.

      Keywords

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