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External fixation versus conservative treatment for distal radial fractures in adults

  1. Helen HG Handoll1,*,
  2. James S Huntley2,
  3. Rajan Madhok3

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 16 MAY 2007

DOI: 10.1002/14651858.CD006194.pub2

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Handoll HHG, Huntley JS, Madhok R. External fixation versus conservative treatment for distal radial fractures in adults. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006194. DOI: 10.1002/14651858.CD006194.pub2.

Author Information

  1. 1

    University of Teesside, Centre for Rehabilitation Sciences (CRS), Research Institute for Health Sciences and Social Care, Middlesborough, Tees Valley, UK

  2. 2

    Royal Infirmary of Edinburgh, University Department of Orthopaedic Surgery, Edinburgh, UK

  3. 3

    University of Manchester, Cochrane Bone, Joint and Muscle Trauma Group, Manchester, UK

*Helen HG Handoll, Centre for Rehabilitation Sciences (CRS), Research Institute for Health Sciences and Social Care, University of Teesside, School of Health and Social Care, Middlesborough, Tees Valley, TS1 3BA, UK. h.handoll@tees.ac.uk. H.Handoll@ed.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Abbaszadegan 1990 {published data only}
  • Abbaszadegan H, Jonsson U. External fixation or plaster cast for severely displaced Colles' fractures? Prospective 1-year study of 46 patients. Acta Orthopaedica Scandinavica 1990;61(6):528-30.
Hegeman 2004 {published data only}
  • Hegeman JH. personal communication October 10 2006.
  • Hegeman JH, Oskam J, Van der Palen J, ten Dius HJ, Vierhout PAM. Primary external fixation versus plaster immobilization of the intra-articular unstable distal radial fracture in the elderly. Aktuelle Traumatologie 2004;34(2):64-70.
Horne 1990 {published data only}
  • Axelrod TS. A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radius fractures. Journal of Orthopaedic Trauma 1991;5:114-5.
  • Devane P, Horne JG. A prospective trial comparing external fixation with closed reduction and cast immobilisation in the treatment of distal radial fractures [Abstract]. Journal of Bone and Joint Surgery - British Volume 1988;70(3):507.
  • Horne G. A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radius fractures [letter; comment]. Journal of Orthopaedic Trauma 1991;5(2):246.
  • Horne G, Devane P. A prospective randomised trial of external fixation and plaster cast immobilisation in the treatment of distal radial fractures [Abstract]. Orthopaedic Transactions 1989;13(3):531.
  • Horne JG, Devane P, Purdie G. A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radial fractures [see comments]. Journal of Orthopaedic Trauma 1990;4(1):30-4.
Howard 1989 {published data only}
  • Freeman BJC, Atherton WG, Howard PW, Burke FD. External fixation or manipulation and plaster for severely displaced comminuted Colles' fractures? [Abstract]. Journal of Bone and Joint Surgery - British Volume 1998;80 Suppl 1:53.
  • Freeman BJC, Atherton WG, Howard PW, Burke FD. External fixation or manipulation and plaster for severely displaced comminuted Colles' fractures? [Abstract]. Journal of Bone and Joint Surgery - British Volume 2000;82 Suppl 2:171.
  • Howard PW, Stewart HD, Hind RE, Burke FD. External fixation or plaster for severely displaced comminuted Colles' fractures? A prospective study of anatomical and functional results. Journal of Bone and Joint Surgery - British Volume 1989;71(1):68-73.
Jenkins 1989 {published and unpublished data}
  • Jenkins NH. The treatment of Colles' fracture [Masters thesis: Winner of Robert Jones Gold Medal and Association Prize 1989]. London: British Orthopaedic Association, 1988.
  • Jenkins NH, Jones DG, Johnson SR, Mintowt-Czyz WJ. External fixation of Colles' fractures. An anatomical study. Journal of Bone and Joint Surgery - British Volume 1987;69(2):207-11.
  • Jenkins NH, Jones DG, Mintowt-Czyz WJ. External fixation and recovery of function following fractures of the distal radius in young adults. Injury 1988;19(4):235-8.
  • Jenkins NH, Jones DG, Mintowt-Czyz WJ. The role of external fixation in treating the Colles' fracture [Abstract]. Journal of Bone and Joint Surgery - British Volume 1989;71(2):340.
Kapoor 2000 {published data only}
  • Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury 2000;31(2):75-9.
Kreder 2006 {published and unpublished data}
  • Agel J. personal communication October 10 2006.
  • Cebesoy O, Isik M. Is external fixation necessary for distal radius fracture without joint incongruity? [letter]. Journal of Orthopaedic Trauma 2006;20(5):374.
  • Kreder HJ, Agel J, McKee MD, Schemitsch EH, Stephen D, Hanel DP. A randomized, controlled trial of distal radius fractures with metaphyseal displacement but without joint incongruity: closed reduction and casting versus closed reduction, spanning external fixation, and optional percutaneous K-wires. Journal of Orthopaedic Trauma 2006;20(2):115-21.
  • Kreder HJ, Hanel DP, Agel J, McKee MD. A randomized controlled trial of closed reduction and casting versus closed reduction and external fixation for distal radius fractures with metaphyseal displacement but without joint incongruity [Abstract]. American Society for Surgery of the Hand 57th Annual Meeting; 2002 Oct 3-5; Phoenix, AZ. 2002.
  • Kreder HJ, Hanel DP, Agel J, McKee MD, Trumble TE. A randomized controlled trial of closed reduction and casting versus closed reduction and external fixation for distal radius fractures with metaphyseal displacement but without joint incongruity [Abstract]. Orthopaedic Trauma Association Annual Meeting; 2002 Oct 11-13; Toronto, Ontario. 2002:http://www.hwbf.org/ota/am/ota02/otapa/OTA02065.htm (accessed 01/11/02).
Lagerstrom 1999 {published data only}
  • Lagerstrom C, Nordgren B, Olerud C. Evaluation of grip strength measurements after Colles' fracture: a methodological study. Scandinavian Journal of Rehabilitation Medicine 1999;31(1):49-54.
  • Lagerstrom C, Nordgren B, Rahme H. Recovery of isometric grip strength after Colles' fracture: a prospective two-year study. Scandinavian Journal of Rehabilitation Medicine 1999;31(1):55-62.
McQueen 1996 {published data only}
  • McQueen MM, Court-Brown CM. Unstable fractures of the distal radius: a prospective randomized comparison of four treatment methods [Abstract]. Orthopaedic Transactions 1997;21(2):595-6.
  • McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius. A prospective randomised comparison of four methods of treatment. Journal of Bone and Joint Surgery - British Volume 1996;78(3):404-9.
Pring 1988 {published data only}
  • Pring DJ, Barber L, Williams DJ. Bipolar fixation of fractures of the distal end of the radius: a comparative study. Injury 1988;19(3):145-8.
  • Pring DJ, Williams DJ. Bipolar fixation of fractures of the distal radius: a comparative study [Abstract]. Journal of Bone and Joint Surgery - British Volume 1986;68(4):666.
Rodriguez-Merchan 92 {published data only}
  • Merchan EC, Breton AF, Galindo E, Peinado JF, Beltran J. Plaster cast versus Clyburn external fixation for fractures of the distal radius in patients under 45 years of age. Orthopaedic Review 1992;21(10):1203-9.
Roumen 1991 {published data only}
  • Roumen RM, Hesp WL, Bruggink ED. Unstable Colles' fractures in elderly patients. A randomised trial of external fixation for redisplacement. Journal of Bone and Joint Surgery - British Volume 1991;73(2):307-11.
Stein 1990 {published data only}
Young 2003 {published and unpublished data}
  • Nanu AM, Pappasaras S, Rangan A, Checketts RG. Plaster cast vs the Pennig dynamic fixator for Colles' fracture - a prospective randomised trial [Abstract]. Journal of Bone and Joint Surgery - British Volume 1994;76 Suppl 2 & 3:149.
  • Young CF. personal communication April 21 2002.
  • Young CF. personal communication August 18 2002.
  • Young CF, Nanu AM, Checketts RG. Plaster immobilisation versus Pennig external fixator for distal radius fractures [Abstract]. Journal of Bone and Joint Surgery - British Volume 2000;82 Suppl 1:83.
  • Young CF, Nanu AM, Checketts RG. Plaster immobilisation versus Pennig external fixator for distal radius fractures [Abstract]. Presentation at the The Third Orthofix Riva Congress; 2000 May 10-14; Riva del Garda, Italy 2000.
  • Young CF, Nanu AM, Checketts RG. Seven-year outcome following Colles' type distal radial fracture. A comparison of two treatment methods. Journal of Hand Surgery - British Volume 2003;28(5):422-6.
  • Young CF, Nanu AM, Checketts RG. Seven year outcome study of Colles' type distal radial fractures [Abstract]. Journal of Bone and Joint Surgery - British Volume 2003;85(Suppl 1):27.
  • Young CF, Nanu AM, Checketts RG. Seven year outcome study of Colles' type distal radial fractures [Abstract]. Presentation at the The Third Orthofix Riva Congress; 2000 May 10-14; Riva del Garda, Italy 2000.
Zheng 2003 {published data only}
  • Zheng HL, Wu F, Guo T, Cai J, Zhang Y. [A comparison of conservative and surgical treatment of distal radius unstable fracture]. Journal of Clinical Orthopaedics 2003;6(3):211-3.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Christensen 2001 {published data only}
  • Christensen OM, Christiansen TC, Krasheninnikoff M, Lind B, Holmich LR, Hansen FF, et al. Plaster cast compared with bridging external fixation for distal radius fractures of the Colles' type. International Orthopaedics 2001;24(6):358-60.
Kongsholm 1989 {published data only}
  • Kongsholm J, Olerud C. Plaster cast versus external fixation for unstable intraarticular Colles' fractures. Clinical Orthopaedics and Related Research 1989;(241):57-65.
  • Olerud C, Kongsholm J. External fixation of comminuted Colles' fractures gives better results than conservative treatment. Zeitschrift fur Unfallchirurgie, Versicherungsmedizin und Berufskrankheiten 1989;82(2):99-105.
Solgaard 1989 {published data only}
  • Solgaard S, Bunger C, Solund K. Displaced distal radius fractures. A comparative study of early results following external fixation, functional bracing in supination, or dorsal plaster immobilization. Archives of Orthopaedic and Trauma Surgery 1989;109(1):34-8.
Sprenger 1988 {published and unpublished data}
  • Sennwald G. personal communication August 1 2002.
  • Sprenger FB, Sennwald G, Weber BG. Therapy of the Colles fracture with external fixative [Abstract] [Die therapie der Colles-fraktur mit fixateur externe]. Hefte zur Unfallheilkunde 1988;200:300.
van Dijk 1996 {published data only}

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Moroni 2004 {published data only}
  • Moroni A, Vannini F, Faldini C, Pegreffi F, Giannini S. Cast vs external fixation: a comparative study in elderly osteoporotic distal radial fracture patients. Scandinavian Journal of Surgery 2004;93(1):64-7.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Ahlborg 1999
Altissimi 1986
  • Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clinical Orthopaedics and Related Research 1986;(206):202-10.
Altman 2003
Amadio 2001
  • Amadio PC. Outcome assessment in hand surgery and hand therapy: an update. Journal of Hand Therapy 2001;14(2):63-7.
Andersen 1996
  • Andersen DJ, Blair WF, Steyers CM Jr, Adams BD, el Khouri GY, Brandser EA. Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. Journal of Hand Surgery - American Volume 1996;21(4):574-82.
Atkins 1989
Atkins 2003
Axelrod 1991
  • Axelrod TS. A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radius fractures [letter; comment] [see comments]. Journal of Orthopaedic Trauma 1991;5(1):114-5.
Belsole 1993
BMJ 2006
  • A guide to the text. Clinical Evidence Online http://www.clinicalevidence.com/ceweb/about/guide.jsp (accessed 24 March 2006).
Capo 2006
  • Capo JT, Swan KG Jr, Tan V. External fixation techniques for distal radius fractures. Clinical Orthopaedics and Related Research 2006;445:30-41.
Chitnavis 1999
  • Chitnavis J. The wrist. In: Pynsent PB, Fairbank JC, Carr AJ editor(s). Classification of musculoskeletal trauma. Oxford: Butterworth Heinemann, 1999:146-70.
Cooney 1980
Cooney 1993
Cummings 1985
Fernandez 1996
  • Fernandez DL, Jupiter JB. Fractures of the distal radius. A practical approach to management. 1st Edition. New York: Springer-Verlag, 1996.
Fernandez 1999
  • Fernandez DL, Palmer AK. Fractures of the distal radius. In: Green DP, Hotchkiss RN, Pederson WC editor(s). Green's Operative Hand Surgery. 4th Edition. New York: Churchill Livingstone, 1999:929-85.
Flinkkila 1998
  • Flinkkila T, Raatikainen T, Hamalainen M. AO and Frykman's classifications of Colles' fracture. No prognostic value in 652 patients evaluated after 5 years. Acta Orthopaedica Scandinavica 1998;69(1):77-81.
Frykman 1967
  • Frykman G. Fracture of the distal radius including sequelae--shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthopaedica Scandinavica Supplementum 1967;108:3-153.
Gartland 1951
  • Gartland JJ, Werley CW. Evaluation of healed Colles' fractures. Journal of Bone and Joint Surgery - American Volume 1951;33(4):895-910.
Handoll 2003a
  • Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults (Cochrane review). Cochrane Database of Systematic Reviews 2003, Issue 3.
Handoll 2003b
  • Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults (Cochrane Review). Cochrane Database of Systematic Reviews 2003, Issue 2. [Art. No.: CD000314. DOI: ]
Handoll 2003c
  • Handoll HHG, Madhok R. From evidence to best practice in the management of fractures of the distal radius in adults: working towards a research agenda. BMC Musculoskeletal Disorders 2003;4(27).
Handoll 2007
  • Handoll HHG, Madhok R, Huntley JS. Different methods of external fixation for treating distal radial fractures in adults. Cochrane Database of Systematic Reviews 2007, Issue 2. [Art. No.: CD006522. DOI: ]
Higgins 2003
Higgins 2005
  • Higgins JPT, Green S, editors. Highly sensitive search strategies for identifying reports of randomized controlled trials in MEDLINE. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]; Appendix 5b. In: The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd.
Jebsen 1969
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Jenkins 1988
Jupiter 1997
Knirk 1986
  • Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. Journal of Bone and Joint Surgery - American Volume 1986;68(5):647-59.
Kreder 1996a
  • Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. X-ray film measurements for healed distal radius fractures [published erratum appears in J Hand Surg [Am] 1996 May;21(3):532]. Journal of Hand Surgery - American Volume 1996;21(1):31-9.
Kreder 1996b
  • Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. Consistency of AO fracture classification for the distal radius. Journal of Bone & Joint Surgery - British Volume 1996;78(5):726-31.
Kreder 2005
  • Kreder HJ, Hanel DP, Agel J, McKee M, Schemitsch EH, Trumble T, et al. Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: A randomised controlled trial. Journal of Bone & Joint Surgery - British Volume 2005;87(6):829-36.
MacDermid 2000
  • MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH. Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. Journal of Hand Surgery - American Volume 2000;25(2):330-40.
MacKenney 2006
Muller 1991
  • Muller M, Allgower M, Schneider R, Willenegger H. Manual of internal fixation: techniques recommended by the AO-ASIF Group. 3rd Edition. Berlin: Springer-Verlag, 1991.
O'Neill 2001
Older 1965
  • Older TM, Stabler EV, Cassebaum WH. Colles fracture: Evaluation and selection of therapy. Journal of Trauma 1965;5(4):469-76.
Pennig 1996
Sahlin 1990
Scheck 1962
  • Scheck M. Long-term follow-up of treatment of comminuted fractures of the distal end of the radius by transfixation with Kirschner wires and cast. Journal of Bone & Joint Surgery - American Volume 1962;44(2):337-51.
Seitz 1993
  • Seitz WH Jr. External fixation of distal radius fractures. Indications and technical principles. Orthopedic Clinics of North America 1993;24(2):255-64.
Singer 1998
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Smith 1988
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Stewart 1984
  • Stewart HD, Innes AR, Burke FD. Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster casts. Journal of Bone & Joint Surgery - British Volume 1984;66(5):749-53.
Stewart 1985
Taleisnik 1984
Van der Linden 1981
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Van Staa 2001
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