ORTHOPAEDIC SURGERY Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius Georg Gradl • Gertraud Gradl • Martina Wendt • Thomas Mittlmeier • Guenther Kundt • Jesse B. Jupiter Received: 22 July 2012 / Published online: 19 February 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Background The aim of this study was to compare non- bridging external fixation to palmar angular stable plating with respect to radiological outcome, wrist function, and quality of life. Methods One hundred and two consecutive patients (mean age: 63 years) were enrolled in the study. Fifty-two patients were randomized for plate osteosynthesis (2.4 mm, Synthes), 50 patients received non-bridging external fixa- tion (AO small fixator). Objective (range of motion, grip strength), patient rated outcomes (quality of life, pain), and radiological outcome were assessed 8 weeks, 6 months, and 1 year after surgery. Results Loss of radial length of more than 3 mm was not detected in any group. Volar tilt was better restored by external fixation (7.2°) than by volar plating (0.1°). Wrist function was good in both groups. The external fixator was tolerated very well, and the quality of life assessment revealed comparable results in both groups. Osteoporosis was found in 54 % of patients and had no influence on radiological and functional outcome. Conclusion Non-bridging external fixation employing multiplanar K-wires is a suitable treatment option in intra- and extra-articular fractures of the distal radius even in osteoporotic bone. Level of evidence Prospective randomized trial, Level I. Keywords Distal radius fracture Á External fixation Á Non-bridging Á Functional outcome Á Volar plating Introduction Treatment of unstable distal radius fractures has evolved over the last two decades from a primary non-operative treatment to operative treatment [1]. The goal of treatment for distal radius fractures is to obtain sufficient pain-free motion, allowing return to activities while minimizing the risk for future degenerative changes or disability [2]. At the same time, demographic changes with an aging population and an increase of fractures with concomitant osteoporosis [3] imply a need for more predictable opera- tive techniques and stable implants [3]. Open reduction and internal fixation (ORIF) of dorsally displaced radial frac- tures employing locking plates through a volar approach has been advocated to be less invasive than dorsal plating [4, 5] and at the same time provide reasonable stability in osteoporotic bone [6], non-bridging external fixation on the other hand, offers a potential benefit in accelerating G. Gradl and G. Gradl contributed equally. G. Gradl Á M. Wendt Á T. Mittlmeier Department of Trauma and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany G. Gradl Á J. B. Jupiter Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachussetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA G. Gradl (&) Department of Trauma and Reconstructive Surgery, University of Aachen, Pauwelstrasse 30, 52074 Aachen, Germany e-mail: ggradl@ukaachen.de G. Kundt Department of Medical Informatics and Biometry, University of Rostock, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany 123 Arch Orthop Trauma Surg (2013) 133:595–602 DOI 10.1007/s00402-013-1698-5