Closed Reduction External Fixation Versus Open Reduction LCP Fixation For Distal Radius Fractures: A Systematic Review

Objective:Distal radius fractures are the most common upper extremity fractures. Closed reduction and external fixation (CREF) technique is a traditional Chinese treatment method with great clinical efficacy. Locking compression plate (LCP) is one of the latest distal radius fracture plate fixation systems. A systematic review was made to compare CREF and LCP for the treatment of distal radius fractures via Meta-analysis, investigating the prognosis of the two methods to get far clinical evidence.Methods:The following six databases had been searched:CENTRAL (Issue 2 of 12,2015), Medline (Jan 1950 to Feb 2015), Embase (Jan 1980 to Feb 2015), CBM (1978 to Feb 2015), CNKI (1994 to Feb 2015), VIP(1989 to Feb 2015), without language specialization. Some relevant documents were also manually retrieved. According to the criteria included, a comprehensive collection of RCT or q-RCT trials were made to compare CREF and LCP. The R software with the extend package series "Meta" were used to do Meta-analysis of the outcomes (radiological indicators, wrist function indicators, wrist function excellence rate, satisfaction rate and complications).Results:The study included 10 eligible trials, at a total of 1089 cases of patients. Of which 457 cases of LCP,632 cases of CREF. The results show that:(1) radiographic indicators:LCP compared to CREF recovered better dorsal tilt (MD=8.92; 95%CI [1.15,16.69]; P=0.02 <0.05), radial inclination (SMD=1.19; 95% CI [0.46,1.92]; P=0.001<0.05), and ulnar variance (SMD=1.42; 95%CI [0.61,2.23]; P=0.0006<0.05); (2) wrist function indicators:LCP fixed better than CREF (SMD=0.33; 95%CI [0.21,0.46]; P<0.00001); (3) wrist function excellence rate:LCP group was higher than CREF group (RR=1.19,95%CI [1.11,1.27], P <0.00001); (4) Complications:LCP group got a lower probability of complications than the CREF group (RR=0.11,95% CI [0.03,0.46], P=0.002); (5) patient satisfaction:12 months after treatment, both groups on treatment satisfaction was not significantly different (P>0.05).Conclusion:According to the trial evidence involved in this study, LCP got better on the selected outcomes than CREF. However, the total number of trials comparing these two treatment methods were rare, the evidence involved was of low level, the sample had limitations, as a result, bias may exist, so the above conclusions had to be verified via more rigorous tests and larger samples.