Randomised study of non-bridging external fixation compared with intramedullary fixation of unstable distal radial fractures.

This is a randomised study to compare two types of osteosynthesis to mobilise wrists after distal fractures of the radius. Inclusion criteria were Older type 2 and 3 fractures. External fixation was managed with Hoffmann II compact non-bridging. Internal fixation was managed with Micronail. Patients were followed up for 12 weeks. The primary outcome was the results of the disabilities of arm, shoulder and hand (DASH) questionnaire. The secondary outcomes were answers to the patient-rated wrist evaluation (PRWE), grip strength, satisfaction, radial length, and volar tilt. Thirty patients were randomised to have external fixation and 31 to have internal fixation.There were no significant differences in DASH score. Internal fixation gave significantly better grip strength at five (p = 0.00) and 12 weeks (p = 0.03). The operating time was significantly shorter (p = 0.00) when non-bridging external fixation was used, and there were minor radiological differences. An activity-based costing analysis showed that external fixation cost three times more overall.