This study was a retrospective cohort study which reviewed patients between January 2011 and July 2017 after receiving institutional review board approval. The inclusion criteria were patients aged > 80 years with a dorsally displaced, distal radius fracture treated with EF or ORIF with a VLP in our institution. We excluded patients with open fractures and/or concomitant injuries. Patients who needed extra procedures such as bone grafting or bone substitutes for fractures were also excluded. There were 74 patients assessed for eligibility in this study. 2 patients who were lost to follow up before 12 months postoperatively and 3 patients expired during the follow-up duration were excluded. There were total 69 patients enrolled in this study for the final analysis. Their demographic data, including age, sex, mechanism of injury, length of hospital stay, chronic diseases, and personal history were recorded.
Preoperative
Preoperative plain anteroposterior- and lateral-view radiographs were evaluated. The important parameters of volar tilt, radial inclination, radial height, and ulnar variance were also recorded. All fractures were classified according to the AO/Orthopaedic Trauma Association classification system from the radiographs [12] by two independent reviewers.
Perioperative
All surgeons had experience of using EF or VLP to treat distal radius fractures. The principle to determine the surgery of EF or VLP was based on the surgeon’s preference. An acceptable reduction was defined as ≤10° dorsal angulation and ≤ 2 mm radial shortening intraoperatively.
External fixation
After closed reduction of the distal radius was performed using traction force, two percutaneous Kirschner-pins were introduced dorsolaterally to maintain the fracture reduction. Two distal external pins were attached in the 2nd proximal metacarpal bone. Two proximal external pins were applied via two small dorsolateral incisions made proximal to the extensor pollicis longus muscle and retracted the extensor carpi radialis longus and brevis tendons. Then, the external fixator frame was applied under fluoroscopic monitoring. Active finger range of motion was started immediately after operation. Two weeks after operation, the dressing and suture were removed. The external fixator and K-pins were extracted 6–7 weeks postoperatively in the clinic then wrist active and passive exercises were started.
VLP fixation
The surgical exposure of the fracture was based on Henry’s approach and the pronator quadratus muscle was incised on its radial border. The fracture was exposed and reduced. The VLP and screws were used for fracture stabilization by fluoroscopic monitoring; if possible, the pronator quadratus muscle was repaired. In this group, the volar short arm splint was placed for immobilization after operation. Active finger range of motion was started after the day of operation. Two weeks after operation, the dressing and suture were removed and active and passive exercises of the wrist were performed. Besides, the removable splint was used for an additional 2 weeks.
Postoperative follow-up
The patients were followed up at the outpatient clinic 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Postoperative immediate radiographs and anteroposterior- and lateral-view radiographs in the final follow-up clinic were evaluated (Fig. 1 and Fig. 2). Volar tilt, radial inclination, radial height, and ulnar variance were recorded and compared with the values on the preoperative plain radiographs [13]. The wrist range of motion was assessed in the final clinical visit. Flexion-extension, and forearm supination-pronation were measured by a goniometer. Any postoperative complications, including infection, neuropathy, complex regional pain syndrome, tendonitis, implant failure, malunion, or nonunion, were also evaluated retrospectively for every patient at each clinical visit.
Statistics
Continuous data are shown as mean ± standard deviation. As the preliminary Kolmogorov-Smirnov test showed that the samples did not follow a normal distribution, we used the Mann-Whitney U test to compare the continuous variables between the external fixator and VLP group. Fisher’s exact test and the chi-squared test were used to compare the categorical variables between the two groups. Within these analyses, values of p < 0.05 were considered statistically significant.