OPEN REDUCTION AND INTERNAL FIXATION VERSUS CLOSED REDUCTION AND EXTERNAL FIXATION FOR UNSTABLE INTRA-ARTICULAR DISTAL RADIUS FRACTURES: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Abstract

Aim and Background: Unstable intra-articular distal radius fractures require restoration of articular congruity and stable fixation to optimize functional recovery. Closed reduction and external fixation (CREF) and open reduction and internal fixation (ORIF) are commonly employed treatment modalities. This prospective randomized controlled trial aimed to compare the functional and radiological outcomes of CREF and ORIF in patients with unstable intra-articular distal radius fractures. Materials and Methods: This prospective, parallel-group, randomized controlled trial included 60 patients with unstable intra-articular distal radius fractures. All 60 screened patients fulfilled the eligibility criteria and were randomly allocated in a 1:1 ratio using computer-generated randomization to either CREF (n=30) or ORIF (n=30). Functional outcomes were assessed using the Modified Mayo Wrist Score (MMWS) and wrist range of motion (ROM). Radiological outcomes included volar tilt, radial inclination, radial height, ulnar variance, and intra-articular step-off. Patients were followed for 6 months. Longitudinal changes and between-group differences were assessed using appropriate statistical methods, with p<0.05 considered statistically significant. Results: The mean age was 53.47 ± 17.15 years in the CREF group and 51.30 ± 17.94 years in the ORIF group. Baseline MMWS was comparable between groups (36.93 ± 5.24 vs. 39.73 ± 4.59; p=0.094). Both groups demonstrated progressive improvement during follow-up; however, the ORIF group showed significantly superior postoperative functional outcomes. At 6 months, the mean MMWS was 77.07 ± 5.12 in the ORIF group compared with 67.10 ± 5.24 in the CREF group (p<0.0001). Wrist ROM was also significantly greater in the ORIF group at 6 months (75.20 ± 4.06 vs. 65.90 ± 5.07; p<0.0001). Radiological parameters remained stable and comparable between groups throughout follow-up. Conclusion: Both CREF and ORIF achieved satisfactory maintenance of radiological alignment. However, ORIF resulted in significantly superior short-term functional recovery and wrist mobility. ORIF may therefore be preferred when early restoration of wrist function is a major treatment objective.