Fixation Technique
We are unable to recommend for or against any one specific operative method for fixation of distal radius fractures.
Rationale
Fourteen clinical trials met the inclusion criteria: 8 combined intra- and extra- articular fractures,29-36 5 studied only intra-articular fractures,37-41 and one studied only extra-articular fractures.42 No studies evaluated shearing/articular rim fractures, or radiocarpal fracture-dislocations. Inclusion was based on inadequate radiographic alignment after initial adequate closed reduction and splint immobilization. Thus, the included studies did not allow for stratification by fracture type. Only two comparisons were made by more than one study making meta-analysis impossible. All had at least one methodological flaw and were downgraded to Level II.
The included studies in this recommendation do not address many important aspects of the operative treatment of distal radius fractures, including different operative treatments for different fracture types. Therefore, it is not possible to come to an evidence based conclusion for the optimal operative treatment of distal radius fractures.
Only three of 14 studies had statistically significant findings. In one study, there was only a statistically significant difference in complications. In another study, there was a possibly clinically important difference in DASH at 1 year but not at 3 or 6 months. In the third study, there was statistically significant better function at 2 years for percutaneous fixation over ORIF. All other outcomes evaluated by the included studies were not statistically significant.
The included studies in this recommendation do not address many important aspects of the operative treatment of distal radius fractures, including different operative treatments for different fracture types. Therefore, it is not possible to come to an evidence based conclusion for the optimal operative treatment of distal radius fractures.
Only three of 14 studies had statistically significant findings. In one study, there was only a statistically significant difference in complications. In another study, there was a possibly clinically important difference in DASH at 1 year but not at 3 or 6 months. In the third study, there was statistically significant better function at 2 years for percutaneous fixation over ORIF. All other outcomes evaluated by the included studies were not statistically significant.