INTRODUCTION: Distal end of radius fractures are more common due to high energy trauma in young individuals and because of 1osteoporosis in older population . There are several treatment modalities for this fractures like cast immobilization, percutaneous k wires and external xation or volar locking plating. Surgical xation enables patients to resume daily activity earlier and more independently. Thus, there has been a trend toward more aggressive fracture xation in patients. Closed or limited open reduction with percutaneous pinning and external xation, which has traditionally been used in unstable intra-articular fractures, does not always lead to anatomic reductions and can result in residual instability with secondary displacement. Volar plates have gained popularity because of their low complication rates and high stability in (2,3,4)osteoporotic bone without joint distraction . In this study we try to compare overall outcome in patients treated with external xator and volar locking plate. MATERIAL METHODS: We included 51 patients of having distal end of radius fracture those came to our institute between year 2015 to 2018. Among them 26 were treated with percutaneous k wire xation and external xator, rest 25 were treated with open reduction and internal xation with volar locking plate. Inclusion criteria for study is more than 18 years of age without any other skeletal injury. Bilateral fracture and open fractures were excluded from the study. All the procedures done under regional or general anaesthesia at the same institute. External xator group: 2.5 mm of two shanz screws were inserted in second metacarpal and 3.5 mm of two shanz screws were inserted into radial shaft proximal to fracture. Frame was constructed using connecting bars and clamps. Reduction was checked under c arm. One k wire from radial styloid and other k wire from lunate fossa of radius inserted in a cross fashion. Pin tract dressing and below elbow slab applied. Volar plating group: Skin incision longitudinally over exor carpi radialis. Tendon sheath opened and tendon retracted radially. Beneath if lies exor pollisis longus which is retracted ulnarlly to expose pronator quadratus and elevated from radial border to expose distal end of radius. Fracture reduction done under image intensier and internal xation done using volar locking plate. Plaster slab was applied till suture removal. Follow up: THBoth group discharged on 4 day and active nger moments are allowed. Suture removal done after two weeks. Active assisted wrist mobilization started in palting group. External xator was removed after 6 weeks followed by wrist mobilization exercise. Further they were followed 1 month, 3 month, 6 month and 1 year clinically as well as radiologically. (1)Radiological criteria for acceptable reduction is 1. Radial inclination of >15degree. 2. Radial shortening of <5 mm compared to the contralateral side. 3. Sagittal tilt between 15 degree dorsal and 20 degree volar tilt. 4. Intra-articular step-off of <2 mm. Evaluation of outcome: Radiologically we use sarmiento modication of lindstrom (5)criteria . COMPERATIVE STUDY BETWEEN VOLAR LOCKING PLATE AND EXTERNAL FIXATOR IN DISTAL END OF RADIUS FRACTURE Original Research Paper Ejajahmed Ansari* Senior Resident, Department of Orthopedics, S C L General Hospital, Ahmedabad *Corresponding Author Orthopedics Objective: to compare the function out come of distal radius fracture in external xator and voalr locking plate. Material and method: 25 pateint treated with volar locking plate and 26 were treated with external xator.both the group were followed up for a period of 1 year. Radiologically evaluation done using sarmiento modication of lindstrom criteria and functional out come as PRWE score. Results: early mobilization and return to activity is an advantage in plating group but in long term almost equal function results external xator group (84%) and plating group (92%) are seen. ABSTRACT KEYWORDS : VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Bhargav Parmar Resident, Department of Orthopedics, S C L General Hospital, Ahmedabad Harshal Damor Assistant Professor, Department of Orthopedics, S C L General Hospital, Ahmedabad Residual deformity Loss of palmer tilt {degrees} Residual shortening {mm} Loss of radial deviation {degrees} Excellent No or signicant 00 <3mm <50 Good Slight 1O to 10O 3 to 6 mm 50 to 90 Fair Moderate 110 to 140 7 to 11mm 100 to 140 Poor severe At least 150 At least 12mm >140 2 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Wrist range of motion was measured in exion, extension, Pronation, Supination, ulnar deviation & radial deviation and was compared with uninjured limb. The overall function of the upper limb was assesses using the GARTLAND & WERLEY SCORE, & PATIENT RATED WRIST EVALUATION SCORE (PRWE). External xator group: Plating group : RESULTS: The result of volar locking plate is summarized below. Functional range of motion of injured wrist after nal follow up is as below: Radiological outcome: Over all functional outcome according to garland and werney scoring system was: DISCUSSION: We use A O classication for our study. Among the external xator group 20 patients of type A and 6 patients were type C. In volar plating group 6 WERE type A , 11 were type B and 8 were type C. No infection was found in any of our patients. Among external xator group, 3 patients had residual dorsal tilt and 3 had grip weakness. Among plating group 2 patients had residual dorsal tilt and one patient had prominent ulnar styloid process. After one year of followup, we found almost equal wrist range of motion in both groups. Radiologically we found almost equal results except for loss of palmer tilt in external xator group. 3 patients had residual dorsal tilt because of comminution and collapse. The advantages of open reduction and internal xation include direct visualization and manipulation of the fracture fragments, stable rigid xation, and the possibility of immediate postoperative motion. The subchondral placement of smooth pegs is useful to buttress small articular fragments and successful ly control shortening and angular displacement, especially in osteoporotic bone. Some studies suggested that CRPS I is more likely to occur after EF than after other surgical procedures. In the current study, there was no signicant difference in the occurrence of CRPS I between the VP and EF groups, which is consistent with other studies.27 This suggests that the high incidence of CRPS I after EF in the literature may be related to the recruitment of subjects with more severe DRFs or excessive (6,7,8)distraction during EF . In the present study, 92 % of volar plating patients and 84% of external xator group patient had an excellent to good result. (10)Gradl et al reported 100 and 97.5 % with good or excellent (9)results in these two groups, respectively. Rozental et al reported similar ndings on exeternal xator and plating group, that both groups doing equally well by 6 months. Recently randomized trials have reported rapid functional recovery after volar plating in the early period after surgery. However, at 1 year, there were no signicant differences between the volar locking plate and external xator groups (13-17)based on objective and subjective functional assessments . In our study we found plating group having slightly superiority in terms of early mobilization and return to activity, however after 1 year there is no signicant difference between these two groups. REFERENCES 1. Rajeev Shukla,Ravi Kant Jain,Neeraj K. Sharma, Ravindra Kumar,External xation versus volar locking plate for displaced intraarticular distal radius fractures: a prospective randomized comparative study of the functional outcomes, J Orthopaed Traumatol (2014) 15:265–270. 2. Orbay JL, Touhami A. Current concepts in volar xed-angle xation of unstable distal radius fractures. Clin Orthop Relat Res. 2006;(445):58e67. 3. Fernandez DL. Should anatomic reduction be pursued in distal radial fractures? J Hand Surg Br. 2000;25(6):523e527. 4. Kawaguchi S, Sawada K, Nabeta Y, et al. Recurrent dorsal angulation of the distal radius fracture during dynamic external xation. J Hand Surg Am. 1998;23(5):920e925. 5. Sarmiento A, Pratt GW, Berry NC, Sinclair WF .Colle's fractures, functional bracing in supination. J Bone Joint Surgery Am 1975;57:311-7 6. Suso S, Combalia A, Segur JM, et al. Comminuted intra-articular fractures of the distal end of the radius treated with the Hoffmann external xator. J Trauma. 1993;35(1):61e66. 7. Hegeman JH, Oskam J, Vierhout PA, et al. External xation for unstable intra- articular distal radial fractures in women older than 55 years: acceptable functional end results in the majority of the patients despite signicant secondary displacement. Injury. 2005;36(2):339e344. 8. Zollinger PE, Kreis RW, van der Meulen HG, et al. No higher risk of CRPS after external xation of distal radial fractures: subgroup analysis under VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Palmer exion Dorsi exion Prona tion Supin ation Radial deviation Ulnar deviation Plating group Average (Degrees) 75 80 87 81 11 25 External xator group Average (degrees) 74 78 75 80 14 30 Loss of radial inclination (degrees) No. of Patients[%] Volar plating No of patients [%] External xator <5 56% 56 % 5-9 32% 40% 10-14 12% 4% >14 0 0 Radial shortening in mm No of Patients volar plating No of patients external xator <03 72% 81% 03-06 28% 15% 07-11 0 4% >11 0 0 Loss of Palmer tilt [degrees] No. of Patients volar plating No of patients External xator 0 24% 28% 1-10 40% 40% 11-14 36% 20% At least 15 0 12% G&W Score Number of patients Volar plating group Number of patients External xator group Excellent 0-2 21( 84%) 20(77%) Good 3-8 2(8%) 2(7%) Fair 9-20 2(8%) 3(12%) Poor >20 0 1(4%) X 3GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS randomised vitamin C prophylaxis. Open Orthop J.2010;(4):71e75. 9. Rozental TD, Blazar PE, Franko OI, et al. Functional outcomes for unstable distal radial fractures treated with open reduction and internal xation or closed reduction and percutaneous xation: a prospective randomized trial. J Bone Joint Surg Am. 2009;91(8):1837e1846. 10. Gradl G, Gradl G, Wendt M, Mittlmeier T, Kundt G, Jupiter JB (2013) Non- bridging external xation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius. Arch Orthop Trauma Surg 133(5):595–602 11. Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC (2005) A meta-analysis of outcomes of external xation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg Am 30:1185–1199 12. Westphal T, Piatek S, Schubert S, Winckler S (2005) Outcome after surgery of distal radius fractures: no differences between external xation and ORIF. Arch Orthop Trauma Surg 125: 507–514 13. Wolfe SW (2009) Patterns and treatment of distal radius fractures.In: Proceedings of the AAOS/ASSH update on the painful and injured wrist. May 29–30, Rosemont, IL, p 66 14. Grewal R, MacDermid JC, King JC, Faber KJ (2011) Open reduction internal xation versus percutaneous pinning with external xation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg 36:1899–1906 15. Kamano M, Honda Y, Kazuki K, Yasuda M (2002) Palmar plating for dorsally displaced fractures of the distal radius. Clin Orthop Relat Res 397:403–408 16. Landgren M, Jerrhag D, Ta¨gil M, Kopylov P, Geijer M, Abramo A (2011) External or internal xation in the treatment of nonreducible distal radial fractures? A 5-year follow-up of a randomized study involving 50 patients. Acta Orthop 82:610–613 17. Wilcke MK, Abbaszadegan H, Adolphson PY (2011) Wrist function recovers more rapidly after volar locked plating than after external xation but the outcomes are similar after 1 year.Acta Orthop 82:76–81 VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 4 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS