Orthopedics and Trauma, NanFang Hospital, Southern Medical University, Guangzhou, China.
Injury. 2012 Jul;43(7):1006-13. doi: 10.1016/j.injury.2011.11.018. Epub 2011 Dec 16.
Whether dynamic or static external fixation is more appropriate for distal radius fractures is still being debated, our aim is to determine the effect of dynamic versus static external fixation for unstable distal radius fractures in terms of postoperative complication, clinical results and radiological outcomes.
We selected PubMed, Cochrane Library, EMBASE, BIOSIS, Ovid and the relevant English orthopaedic journals and pooled data from eligible trials including six eligible randomised controlled trials and two comparative studies containing 998 patients comparing dynamic and static external fixation for unstable distal radius fractures to conduct a sub-group analysis according to different periods of follow-up, aiming to summarise the best available evidence.
The results showed there was an increased risk for pin-track infection in dynamic external fixation group than that in static external fixation group, however, there was the trend of obtaining better clinical effect towards less malunion in dynamic external fixation group, although the results were not statistically significant. With regard to clinical results, range of motion such as extension, supination and pronation were superior in dynamic external fixation group than that in static external fixation group at 6 weeks postoperatively. And there were the trend of obtaining better clinical effect in dynamic external fixation group towards pronation at one year follow-up and grip strength at six weeks, six months and one year follow-up, although no significant differences were viewed. With regard to radiological outcomes, better clinical result was obtained in terms of radial length in dynamic external fixation group immediately after surgery and at six weeks, one year follow-up postoperatively.
The final results show that there are some evidences supporting the use of dynamic external fixation, which may also have practical advantages over static fixation by allowing earlier limb mobility during the fixation period and enabling such patients to maintain their independence. Limitations remain, a cost-effectiveness analysis and DASH-score assessments at all follow-up evaluations should be more carefully considered and reported in a reliable, consistent and standardised manner.
对于桡骨远端骨折，究竟是动态还是静态外固定更合适仍存在争议，本研究旨在从术后并发症、临床结果和影像学结果方面，确定不稳定桡骨远端骨折采用动态与静态外固定的效果。
我们检索了 PubMed、Cochrane 图书馆、EMBASE、BIOSIS、ovid 和相关的英文骨科期刊，并纳入了 6 项符合条件的随机对照试验和 2 项比较研究的数据，这些研究共纳入 998 例不稳定桡骨远端骨折患者，比较了动态和静态外固定的效果，根据不同的随访时间进行了亚组分析，旨在总结最佳现有证据。
结果显示，动态外固定组的针道感染风险增加，但动态外固定组的愈合不良发生率较低，临床效果较好，尽管差异无统计学意义。在临床结果方面，术后 6 周，动态外固定组的活动度（伸、旋前和旋后）优于静态外固定组。在 1 年随访时，动态外固定组的旋前和 6 周、6 个月和 1 年随访时的握力有更好的临床效果趋势，尽管差异无统计学意义。在影像学结果方面，动态外固定组在术后和 6 周、1 年随访时的桡骨长度的临床效果更好。
最终结果表明，有一些证据支持使用动态外固定，与静态固定相比，它可能具有一些实际优势，即在固定期间允许更早地进行肢体活动，并使患者能够保持独立性。但仍存在一些局限性，应更仔细地考虑和报告成本效益分析和 DASH 评分评估，并以可靠、一致和标准化的方式报告。
