| Purpose: To evaluate the effective and safety of external fixation(EF) and open reduction and internal fixation(ORIF) for the unstable distal radius fractures in adults.Methods: We searched MEDLINE(1966 to September 2008),Cochrane Central register of controlled Trails (The Cochrane Library,Issue 3,2008) and EMBASE(1998 to 2008 week 36),CBM,CNKI, and collect randomized controlled trials of EF and ORIF for the unstable distal radius fractures in adults. The quality of included studies was critically assessed and data analysis were performed with Cochrane Collaboration's RevMan 5.0.Results: Seven articles were included in the review(917 patients) ,EF:314,ORIF:324;and only one study has relative high quality, all the others have some limitation in randomization, blinding, allocation concealment. The results of data analysis: : the results of effective : from the Gartland and Werley point system that the ORIF group was better than the EF group with statistic difference[RR=0.71,95%CI(0.54,0.93)], P=0.01;because of the original studies did not offer the detailed datas include pad strength, grip strength, flexion/extension, radial deviation, ulnar deviation, we only process the discriptive analysis. : results of complications: the infection rate of the pin track was higher that EF VS ORIF with statistic difference [RR=1.82, 95%CI(1.13,2.92], P=0.02; the others which included without difference :RSD [RR=1.08, 95%CI(0.28,4.14] , P=0.29;extensor tendon rupture [RR=0.26, 95%CI(0.03 , 2.31] , P=0.23 ; compartment syndrome [RR=0.32, 95%CI(0.05,1.95], P=0.22Conclusions: Compared with EF, the ORIF can achieve the better Gartland and Werley points and much less infection rate., but because of the limitation of the qualities of the studies and the quantities we recommended when used the evidences of our systematic reviewe , so we need consulted the practice situation and in the future we also need the more large sample randomized clinical trails. |
