Widman 2002.
| Methods | Randomised using a random numbers table Assessor blinding: not reported Intention‐to‐treat analysis: likely (full baseline data not provided for all participants) Loss to follow up: 3 (at 1 year) | |
| Participants | Teaching Hospital, Sweden 48 participants Inclusion criteria: severely displaced and comminuted distal radial fracture, Older type 3 [radial styloid process shortened > 4 mm distal to ulna] or type 4 [marked comminution and radial styloid process shortened to level of ulna or less]. Informed consent, aged 20 to 70 years Exclusion criteria: earlier injury of either wrist Classification: Older (type 3 & 4); AO (A2, A3, C1, C2, C3) (extra‐articular and intra‐articular) Sex: 33 female Age: (of 43) mean 51.5 years, range 20 ‐ 69 years Assigned: 24/24 [bone graft & Ext‐fix / Ext‐fix alone] Assessed: 23/22 (at 1 year) | |
| Interventions | Timing of intervention: after treatment at A&E department (1) Bone graft with external fixation and early mobilisation. Closed and open reduction, external fixation (using a half‐frame Hoffman external fixator) and primary bone grafting (from iliac crest) under general anaesthesia. Two pins inserted into 2nd metacarpal and 2 into radial shaft. A 3‐4 cm long incision at dorsum of wrist to expose fracture area and pack cancellous bone graft into fracture cavity. External fixator for 3 weeks, then plaster cast, allowing volar flexion but limited extension, for 3 weeks. (2) External fixation alone. Closed reduction and same external fixator and application but under regional intravenous block. Removed after 6 weeks. | |
| Outcomes | Length of follow up: 1 year. (1) Functional: severe impairment, grip strength, range of movement (flexion and extension, pronation and supination). (2) Clinical: Complications: malunion, pin track infection, CTS, tendon rupture (EPL), superficial painful granuloma, serious donor site (graft) complication (bleed) (3) Anatomical: X‐ray at pre‐op, post‐op and 1 year. Dorsal angulation, radial shortening, severe malunion |
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| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment? | Unclear risk | B ‐ Unclear |
<: less than >: more than A+E: accident and emergency AO: Arbeitsgemeinschaft fur Osteosynthesefragen / Association for the Study of Internal Fixation (or ASIF) CTS: carpal tunnel syndrome DISI: dorsal intercalated segment instability EPL: extensor pollicis longus (tendon) Ext‐fix: external fixation K‐wires: Kirschner wires paraesthesia: numbness, tingling, "pins and needles" sensation POP: plaster of Paris ROM: range of movement (wrist and forearm) RSD: reflex sympathetic dystrophy VAS: visual analogue scale VISI: volar intercalated segment instability X‐pins: crossed percutaneous pinning
References (listed above but not in Additional references) * Lidstrom 1959 Lidstrom A. Fractures of the distal end of the radius. A clinical and statistical study of end results. Acta Orthopaedica Scandinavica Supplementum 1959; 41:5‐118.