Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: a retrospective study of 588 patients.

BACKGROUND AND PURPOSE

Bridging external fixation is used more frequently than non-bridging fixation in the management of unstable distal radius fractures, despite evidence from randomized controlled trials of better outcome with the latter technique. This study was designed to investigate the generalizability of the technique of non-bridging external fixation, and to define the indications for the use of each technique and their complications.

METHODS

641 patients with unstable displaced fractures of the distal radius were treated with bridging or non-bridging external fixation. Non-bridging external fixation was used where there was space for pins in the distal fragment. 52 patients were lost to follow-up, leaving 588 patients available for study. Complete data from radiographic measurements after fracture healing were available for 546 patients. 59 % of fractures were treated with the non-bridging technique.

RESULTS

Fractures treated with bridging external fixation had a 6 times increased risk of dorsal malunion (p < 0.001) and a 2.5 times increased risk of radial shortening (p < 0.001) after adjusting for confounding factors (95% CI for odds ratio: 3-13 and 1.5-4, respectively) compared to non-bridging techniques. Minor pin tract infections were more common in the non-bridging group.

INTERPRETATION

Non-bridging external fixation of the distal radius is a generalizable technique, and reduces the risk of dorsal malunion compared with bridging external fixation. Major complication rates are low and the technique is applicable to most unstable fractures of the distal radius. We recommend that non-bridging external fixation be used where there is space for the pins in the distal fragment.