Objective To evaluate the efficacy of external fixation after closed reduction and internal fixation with steel plate after open reduction in the treatment of distal radius fracture (DRF) using a systematic review.
Methods We retrieved publicly available databases, such as Pubmed, CNKI, and Wanfang, and to collect randomized controlled trail (RCT) about these two kinds of public tables from the inception of the database to July 2023. The retrieved literature was screened manually, and for the final included studies, Cochrane risk bias assessment tool was used to assess the quality of bias risk, and RevMan 5.4 software was used for Meta-analysis. The advantages and disadvantages of the two postoperative imaging, functional scores and complications were compared.
Results A total of 1 845 patients were included in 20 RCT literatures, including 928 patients in external fixator group and 917 patients in internal fixation with steel plate group. Meta-analysis results showed that there were significant differences inthe two treatment methods with respect to the ulnar deviation angle (MD=-0.72, 95%CI: -1.35--0.10, P=0.02) of the two treatments, ulna variation （MD=0. 80, 95%CI: 0.59-1.01, P＜0.001）, pronation （MD=-2.60, 95%CI: -4.88--0.31, P=0.03）, visual analog scale (VAS) score （MD=0.10, 95%CI: 0.02- 0.17, P=0.01）, and the infection rate （RR=5. 18, 95%CI: 2.50-10.73, P＜0.001）, and the internal fixation group was better than the external fixation group. However, there were no significant differences with respect to the palmar inclination angle （MD=0.35, 95%CI: -3.40-4.11, P=0.85）, height of radius （MD=-0.50, 95%CI: -1.26-0.27, P=0.21）, grip strength （MD=-0.15, 95%CI: -0.51-0.20, P=0.40）, dorsiflexion （MD=-3.84, 95%CI: -9.60-1.91, P=0.19）,palmar flexion （MD=-2.12, 95%CI: -6.47-2.24, P=0.34）, supination （MD=-3.22, 95%CI: -6.46-0.02, P=0.05）, radial deviation （MD=-0.01, 95%CI: -0.82-0.85, P=0.98）, ulnar deviation （MD=-0. 00, 95%CI: -0.33-0.33, P=0.98）, the disabilities of the arm, shoulder, and hand (DASH) score （MD=0.07, 95%CI: -3.02-3.16, P=0.96）, the total incidence of complications （RR=1.10, 95%CI: 0.94-1.27, P=0.23）, and the incidence of complex regional pain syndrome （RR=1.70, 95%CI: 0.96-3.03, P=0.07）.
Conclusion Based on the current data, the open reduction and internal fixation with steel plate group is superior to the external fixation group in the recovery of ulnar deviation angle, ulnar variation, pronation movement and infection rate, but there is no significant difference between the two groups in palm inclination angle, reduction of radial height, recovery of grip strength, range of motion such as radial and ulnar deviation or supination, DASH score and total complication rate.
