SCIENTIFIC ARTICLE Open Reduction Internal Fixation Versus Percutaneous Pinning With External Fixation of Distal Radius Fractures: A Prospective, Randomized Clinical Trial Ruby Grewal, MD, MSc, Joy C. MacDermid, MSc, PhD, Graham J. W. King, MD, MSc, Kenneth J. Faber, MD Purpose The purpose of this randomized clinical trial was to investigate the functional outcomes of the surgical treatment of distal radius fractures, comparing treatment by external ﬁxation and percutaneous pinning to open reduction and internal ﬁxation (ORIF) using a plate. Methods We randomized 53 patients with distal radius fractures that failed closed reduction and casting to ORIF (n = 27) or external ﬁxation (n = 26). For pragmatic reasons, the choice of ORIF was left to the surgeon’s discretion (early recruitment, dorsal plates [n = 9]; later recruitment, volar locked plates [n = 18]). Outcomes were measured before surgery, at 6 weeks, and at 3, 6, and 12 months and included the Patient-Rated Wrist Evaluation (PRWE); Disabilities of the Arm, Shoulder, and Hand; range of motion; grip strength; and serial radiographic analysis. Generalized linear modeling using repeated measures was used to identify differences in outcome scores between ﬁxation types over time. Other continuous variables were analyzed using the Student t -test or one-way analysis of variance for multiple groups. Results There were no differences in the demographic characteristics or fracture severity between groups. Based on generalized linear modeling, on average, the ORIF group scored 11 points lower on the PRWE across all time points compared to the external ﬁxation group. The PRWE detected higher pain and disability with external ﬁxation before surgery, at 6 weeks, and at 3 months. Using generalized linear modeling, a post hoc subgroup analysis identiﬁed signiﬁcantly better (15-point advantage) PRWE scores averaged across all time points with volar locking plates compared to both external ﬁxation and dorsal plating. Conclusions The PRWE scores were signiﬁcantly lower for patients treated with ORIF compared to those with external ﬁxation, with the best outcomes observed with volar locking plates. These advantages were observed in the early postoperative period, and overall scores equalized at 1 year. A higher mean initial preoperative PRWE score was seen with external ﬁxation, perhaps indicating a more severe initial injury. Given this difference, the interpre- tation of these results is not clear. (J Hand Surg 2011;36A:1899–1906. Copyright © 2011 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic I. Key words Colles fracture, distal radius fracture, external ﬁxation, open reduction and internal ﬁxation, randomized clinical trial. From the Division of Orthopedic Surgery, University of Western Ontario, Hand and Upper Limb Center, St Joseph’s Health Care, London, Ontario, Canada. Received for publication April 25, 2011; accepted in revised form September 16, 2011. This study was funded through a research grant awarded by the Physicians Services Incorporated Foundation. No beneﬁts in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Ruby Grewal, MD, MSc, Division of Orthopedic Surgery, University of West- ern Ontario, Hand and Upper Limb Center, St Joseph’s Health Care, 268 Grosvenor St, London ON, N6A 4L6, Canada; e-mail: rgrewa@uwo.ca. 0363-5023/11/36A12-0001$36.00/0 doi:10.1016/j.jhsa.2011.09.015 ©  ASSH  Published by Elsevier, Inc. All rights reserved.  1899