External Fixator Versus Small Splint In Complicated Distal Radius Fractures:a Meta-analysis

Objective:To compare the effect of external fixator versus small splint in complicated distal radius fractures through Meta-analysis, regarding clinical results, radiological outcomes and postoperative complications. Then discuss which method is better, and to provide some guidance for the clinic treatment through the study.Methods:According to Cochrane Systematic Review, Cochrane Library(Issue4,2012), MEDLINE (1966-2012.12), EMbase(1974-2012.12), CBM(1978-2012.12), CNKI (1979-2012.12), VIP (1989-2012.12) were searched for the randomized controlled trials of external fixator versus small splint in complicated distal radius fractures in all adults, and gray literatures about orthopedic had been also searched, all bibliographies were without limitation of language, Methodology quality of literatures used evaluate method the Cochrane Collaboration recommended, which was graded to A, B, C. Furthermore, Jadad score was consulted. And analyzed wrist functions, radiological outcomes(including volar tilt angle, ulnar inclination angle, the length of radial shortening), complications and satisfaction though Meta analysis. The analysis was performed with software RevMan5.1.Results:A total of8RCTs with a total of713participants were included. The results of Meta-analysis showed that compared with small splint fixation group, wrist functions [RR=1.25,95%CI (1.14,1.38), P<0.00001] and radiological outcomes[RR=1.24,95%CI(1.10,1.39), P=0.0003] were superior in the external fixation group. Meanwhile, the loss of volar tilt angle[MD=4.85,95%CI(3.93,5.85), P<0.00001] and ulnar inclination angle[MD=3.63,95%CI(2.67,4.60), P<0.00001] were smaller and the length of radial shortening[MD=-3.42,95%CI(-3.74/-3.09), P<0.00001)]was shorter after six months follow-up in the external fixation group. And external fixator fixation led to significantly fewer total complications [RR=0.62,95%CI(0.48,0.80), P=0.0003]. Only one study reported the patient satisfaction with treatment, its result showed that there was no significant difference between external fixator group and small splint group in satisfaction (P<0.05).Conclusion:Based on the existing evidence, external fixator is a better alternative to small splint for complicated distal radius fractures. However, owing to imperfection of methodology and the limitation of samples in the existing research, more high quality, large scale and multicentric randomized controlled trials are required for more accurate conclusion, the Paper concludes just have a referential value.