Dynamic versus static external fixation for unstable distal radius fractures: an up-to-date meta-analysis

Abstract

Objects: 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.

Methods: 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.

Results: 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.

Conclusions: 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.