[Effectiveness comparison between minimally invasive surgery and traditional open reduction internal fixation in treatment of unstable distal radial fractures].

Objective: To compare the effectiveness of minimally invasive percutaneous internal fixation and traditional open reduction via Henry approach and internal fixation in the treatment of unstable distal radial fractures.

Methods: Fifty-six patients with unstable distal radial fractures that met the selection criteria between October 2013 and December 2014 were randomly divided into minimally invasive group (26 cases) and traditional group (30 cases). They were treated with oblique T-shaped locking plate internal fixation via minimally invasive percutaneous approach or traditional Henry approach. There was no significant difference in gender, age, side, causes of injury, fracture classification, and time from injury to operation between 2 groups ( P >0.05). The length of incision, operation time, intraoperative blood loss, hospitalization time, and fracture healing time were recorded in 2 groups. The difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation were compared between 2 groups. The visual analogue scale (VAS) score, the percentage of the lateral wrist flexion and extension range, forearm rotation, and the hand grip strength (recorded as FS%, FR%, and HG% , respectively) were compared between 2 groups at 4 weeks and 3 months postoperatively. The wrist function was evaluated through the disability of arm-shoulder-hand (DASH) scores at 3 months postoperatively.

Results: The length of incision, operation time, intraoperative blood loss, and hospitalization time in minimally invasive group were significantly less than those in traditional group ( P <0.05). The incisions of 2 groups were all achieved primary healing. All patients were followed up 10-16 months (mean, 12.6 months). There was no radial artery injury, screw too long, or screw entering the joint space. In minimally invasive group, 1 patient had the symptoms of median nerve irritation after operation, and recovered completely at 1 month; in traditional group, there were 2 cases of tendon irritation after operation. There was no significant difference in the fracture healing time, the difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation between 2 groups ( P >0.05). At 4 weeks after operation, the VAS score in minimally invasive group was significantly less than that in traditional group, and the FS%, FR%, and HG% were significantly higher than those in traditional group ( P <0.05). There was no significant difference in above indicators between 2 groups at 3 months after operation ( P >0.05). The DASH score in minimally invasive group was significantly less than that in traditional group at 3 months after operation ( t =-5.308, P =0.000). The patient's aesthetic evaluation of postoperative wound in minimally invasive group was better than in traditional group.

Conclusion: For treatment of unstable distal radial fractures, the metacarpal minimally invasive internal fixation has the advantages of smaller wound, incisional concealment, and quicker recovery of wrist joint.