Unstable Colles' fractures in elderly patients. A randomised trial of external fixation for redisplacement. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Cast or external fixation for fracture of the distal radius. A prospective study of 126 cases. Recovery of isometric grip strength after Colles' fracture: a prospective two-year study. A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radial fractures. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. Seven-year outcome following Colles' type distal radial fracture. A comparison of two treatment methods. Bipolar fixation of fractures of the distal end of the radius: a comparative study. External fixation or plaster cast for severely displaced Colles' fractures? Prospective 1-year study of 46 patients. A randomized, controlled trial of distal radius fractures with metaphyseal displacement but without joint incongruity: closed reduction and casting versus closed reduction, spanning external fixation, and optional percutaneous K-wires. Plaster cast versus Clyburn external fixation for fractures of the distal radius in patients under 45 years of age. External fixation or plaster for severely displaced comminuted Colles' fractures? A prospective study of anatomical and functional results.
We report the results of a prospective randomised controlled trial of the management of 101 Colles' fractures in patients over the age of 55 years. Within two weeks of initial reduction 43 fractures had displaced with either more than 10 degrees dorsal angulation or more than 5 mm radial shortening. These patients were randomly divided into two groups: 21 were remanipulated and held by an external fixator; in the control group of 22 patients, the redisplacement was accepted and conservative treatment was continued. Patients treated with external fixation had a good anatomical result, but their function was no better than that of the control group. We found no correlation between final anatomical and functional outcome, and concluded that the severity of the original soft-tissue injury and its complications are the major determinants of functional end result. Fractures of the distal end of the radius are common injuries and are the commonest bony injury around the wrist. Management of these fractures has remained controversial as far as modality of treatment is concerned. In this study 90 adult cases of acute displaced intra-articular fractures of the lower end of the radius were classified according to Frykman's and AO classifications after obtaining radiographs in antero-posterior and lateral planes. These were randomly treated by one of three methods: (1) closed reduction and plaster immobilisation, (2) external fixation and (3) open reduction and internal fixation, and were followed for an average of 4 yr. In the final functional assessment (Sarmiento) the results were (1) plaster 43% good and excellent, 50% fair and 7% poor, (2) external fixator 80% good and excellent, 20% fair and poor results, (3) open reduction and internal fixation 63% good and excellent, 26% fair, 11% poor. We recommend that displaced severely comminuted intra-articular fractures should be treated with an external fixator. In a prospective 4-year study, 126 consecutive patients with a fracture of the distal radius were followed. Functional, anatomic, and radiographic final results of fixation with above-the-elbow cast immobilization were compared with the results obtained with external fixation. The results following external fixation of comminuted intraarticular fractures were better than those of similar fractures treated in a cast. Aged osteoporotic patients tolerated better residual deformities, and the clinical results had a relatively low correlation with the final anatomic alignment. We suggest that extraarticular fractures of the distal radius should be treated with cast immobilization. Comminuted intraarticular fractures of the distal radius should be treated with external fixation, which maintains accurate anatomic position until solid fracture healing is achieved. Grip strength during short and sustained maximal voluntary isometric contractions was measured in 28 females and 5 males with displaced Colles' fracture involving the distal radio-ulnar joint. The patients were randomized into two groups, treated either through immobilization with plaster cast or with external fixation. The recovery of isometric grip strength was followed over a two-year period. A significant difference was registered between women with plaster casts and women with external fixators six weeks after the fracture. Regaining of grip strength occurred up to one year after the fracture. The pattern of recovery was slower for women with primary external fixation. Neither the dominant nor the non-dominant injured side regained short or sustained maximal voluntary isometric contraction. The dominant injured side showed no significant difference between sides but the non-dominant injured side remained significantly weaker. It is thus important to identify hand dominance. Pain during measurements was reduced after two years, but about one-fifth of the patients still perceived pain. The present findings may serve as guidance in physiotherapy for these patients. Distal radial fractures are common, and many methods of treatment have been reported but there are no studies that compare the different treatment methods. This randomized prospective study demonstrated no advantage in using an external fixator to immobilize reduced distal radial fractures over closed reduction and plaster cast immobilization in patients less than 60 years of age. The external fixator group had a significant complication rate. We performed a prospective, randomised trial on 120 patients with redisplaced fractures of the distal radius comparing four methods of treatment. The four treatment groups, each containing 30 patients, were remanipulation and plaster, open reduction and bone grafting, and closed external fixation with and without mobilisation of the wrist at three weeks. The radiological results showed improvement in angulation of the distal radius for the open reduction and bone grafting group. Functional results at six weeks, three and six months and at one year, however, showed no difference between any of the four groups. The main influence on final outcome was carpal malalignment which had a statistically significant negative effect on function. Eighty-five patients were reviewed 7 years after prospective randomization to bridging external fixation or plaster immobilization for treatment of a Colles' type distal radial fracture. The Gartland and Werley score showed that most patients in each group had an excellent or good outcome and patient satisfaction was comparable and high in both groups. The fixator group had significantly less radial shortening (P<0.05). Despite a high level of radiographic malunion (50%) overall function, range of movement and activities of daily living were not limited. Twenty-five per cent of patients had minor radiological signs of post-traumatic arthritis although only one patient was symptomatic. We conclude that, in the long term, external fixation of distal radius fractures does not confer an improved outcome when compared to plaster immobilization. This paper reports a prospective study of the treatment of Colles' fractures, either by bipolar fixation or a forearm cast. Bipolar fixation reduced the degree of secondary displacement and no patient required a repeat manipulation. The functional results at 6 months, as assessed by the Scheck system, showed a strong trend in favour of bipolar fixation, but did not reach 95 per cent confidence limits. The technique of bipolar fixation proved to be safe and suitable for use in a busy district general hospital, without the necessity of elaborate equipment. In a prospective randomized study of 47 severely displaced Colles' fractures, 23 had external fixation and 24 had a dorsal plaster cast. Five fractures in the plaster-cast group redislocated and were externally fixed at rereduction after the 11-day follow-up. Three patients in the external-fixation group had a noncomplicated pin-tract infection, and 1 patient had a transient sensory disturbance arising from the cutaneous branch of the superficial radial nerve. After 1 year, the patients allocated to primary external fixation had a better radiographic and functional end result; according to Lidström's grading, 19/22 were excellent or good after external fixation as compared with 12/19 after plaster-cast treatment. To compare closed reduction and casting with closed reduction and external fixation with optional K-wire fixation for distal radius fractures with metaphyseal displacement but without joint incongruity.
                Prospective study.
                Multicenter study at 3 University teaching hospitals.
                A total of 113 skeletally mature patients with distal radius fractures with metaphyseal displacement, but without joint incongruity, were randomized to receive 1 of 2 standardized treatment protocols. Patients were evaluated at 6 weeks, 6 months, 1 year, and 2 years.
                Closed reduction and casting (n = 59) or closed reduction and external fixation (n = 54).
                Upper extremity function was measured using upper extremity MFA domain scores, overall Jebsen Taylor scores, and pinch and grip strength tests. Global function and pain were measured using the SF-36. Radiographic evaluation and range of motion were documented.
                Upper extremity MFA scores, Jebsen Taylor scores, SF-36 bodily pain scores, and grip strength improved significantly during the first year for all patients. By 2 years, mean Jebsen Taylor scores and SF 36 bodily pain scores for patients in both groups were similar to scores for normal age- and gender-matched population controls. At all points, there was a trend for better function in the external fixation; however, this did not reach statistical significance. There was a trend for better length and palmar tilt restoration with external fixation.
                For distal radius fractures with metaphyseal displacement but with a congruous joint, there exists a trend for better functional, clinical, and radiographic outcomes when treated by immediate external fixation and optional K-wire fixation. In this prospective study, 70 patients between the ages of 20 and 45 years with comminuted intra-articular fractures of the distal radius of types III to VIII (graded according to Frykman) were treated either by closed reduction and forearm plaster (35 patients) or by application of a Clyburn dynamic external fixator (35 patients). The external fixator was more effective at holding the manipulated position, and the roentgenographic loss of position during fracture union was minimal compared with that seen in patients treated in plaster. Functional results in the fixator group were 18 excellent, 10 good, 6 fair, and 1 poor. The plaster group showed the following functional results: 12 excellent, 8 good, 10 fair, and 5 poor. The external fixator generated significantly better anatomical and functional results than did treatment with forearm plaster. A good anatomic position combined with early rehabilitation of the wrist function produced very favorable functional results in patients less than 45 years of age. We report a prospective, randomised, controlled trial of 50 severely displaced comminuted Colles' fractures treated by either external fixation or manipulation and plaster. Each patient was assessed radiographically throughout treatment, and functionally by an independent observer at three and six months. The functional result correlated with the anatomical result, which was significantly better in patients treated by external fixation. This resulted in significantly improved function especially in young patients, and also a lower complication rate. We recommend the use of external fixation for young patients with comminuted displaced Colles' fractures unless manipulation and plaster show excellent reduction.