Wrist Spanning versus Non Spanning Technique of External Fixation in Distal Radius Fractures: A Randomised Clinical Trial

Abstract

Introduction: External fixation is one of the treatment options for unstable Distal Radius Fractures (DRF). Extra-articular variety of DRF can be managed by both wrist joint spanning and non spanning types of external fixators. Literature comparing the outcome of these two techniques is scarce. Aim: To compare and evaluate the results of treatment of DRF with wrist spanning and non spanning techniques. Materials and Methods: A randomised clinical trial study was carried out at Medical College and Hospital, Kolkata, India from November 2017 to January 2019. It included 30 patients, 15 had been treated by spanning and 15 by non spanning external fixators. They were evaluated during the immediate postoperative period, six weeks, nine weeks, and 12 weeks after surgery using digital roentgenography, Disability of Arm, Shoulder, and Hand (DASH) questionnaire, and Visual Analog Scale (VAS) for pain and clinical assessment. A radiological assessment of volar tilt, radial height, and radial inclination was done and the data was normally distributed and analysed by unpaired t-test. Results: The DASH score was better at 12 weeks in the non spanning group, with a mean of 21.89 in spanning vs 19.3 in the non spanning group (p-value 0.0412). At 12 weeks, the mean and p-value for the spanning and non spanning group: range of flexion (61.87 and 70.46), extension (66.13 and 71.13, p-value=0.0053), supination (73.2 and 74.9) and pronation (77.20 and 79.8). For spanning and non spanning groups, the volar tilt mean was 2.33 and 0.60 with a p-value of 0.0042 and the radial length mean was 1.27 and 0.33 with p-value 0.0013, in favour of the non spanning technique. Conclusion: According to the present study, Non spanning external fixation is a better operative technique than spanning external fixation. Unstable DRFs can be treated better by a non spanning external fixator.

Keywords

• extra-articular
• external fixator
• supination
• volar tilt