In older people, a 'broken wrist' (from a fracture at the lower end of one of the two forearm bones) can result from a fall onto an outstretched hand. Treatment usually involves reduction (putting the broken bone back into position) and immobilising the wrist in a plaster cast (conservative treatment). Surgery may be considered for more seriously displaced fractures. One type of surgery is external fixation, in which metal pins are driven into bone, generally via small skin incisions, on either side of the fracture. These pins are then fixed externally by incorporation into a plaster cast or securing into the frame of an external fixator. The external component holds the bony fragments in position while the bone heals. This review looked at the evidence from randomised controlled trials comparing external fixation with conservative treatment.
Fifteen trials, involving 1022 adults with potentially or evidently unstable fractures, were included. While all trials compared external fixation versus plaster cast immobilisation, there was considerable variation in their characteristics especially in terms of patient characteristics and the method of external fixation. Weak methodology, such as using inadequate methods of randomisation and outcome assessment, means that the possibility of serious bias can not be excluded.
The review found that external fixation reduced fracture redisplacement that prompted further treatment and generally improved final anatomical outcome. It appears to improve function too but this needs to be confirmed. The complications, such a pin tract infection, associated with external fixation were many but were generally minor. Serious complications occurred in both groups. The review concludes that there is some evidence to support the use of external fixation for these fractures.