OBJECTIVETo compare the differences of the efficacy between the conservative treatment and surgical treatment for unstable distal radius fractures with surgical indications.

METHODSFrom March 2008 to July 2011, the patients with unstable distal radius fractures were devided into the surgical treatment group and the conservative treatment group in a non randomized manner. In the surgical group,there were 16 males and 32 females with an average age of 50.26 years old ranging from 22 to 76 years; in the conservative treatment group there were 10 males and 27 females with an average age of 51.12 years old ranging from 42 to 79 years. The patients of two groups were almost all with falling damage trauma,which accounting for 92.94% (79/85), all the patients were closed injury, 41 cases were in the left side, and 44 cases in the right. Fracture in accordance with AO classification: C1 in 12 cases, C2 in 32 cases, C3 in 38 cases, B3 in 3 cases. Patients in the surgical treatment group were treated with volar locking compression plate (LCP) fixation and patients in the conservative were treated with manual reduction and plaster external fixation. The active wrist range of motion, pain assessment, subjective evaluation, Gartland and Werley score, Batra radiology score and complications were observed in the last follow-up.

RESULTSForty-three patients in the surgical treatment group were followed up for an average time of 8.03 months (4 to 15 months); 33 paitents in the conservative group were followed up for an average time of 6.54 months (2 to 9 months). The difference of the wrist joint active dorsiflexion and supination rotation range in the two groups were statistically significant (t = 2.212, P < 0.05; t = 2.392, P < 0.05); the difference of the proportion of patients with ulnar wrist pain in the two groups was statistically significant (chi2 = 5.71, P < 0.05); the difference of patients' subjective evaluation score of two groups was statistically significant (Z = 2.13, P < 0.05); the difference of Gartland and Werley score between the two groups was statistically significant (Z = 2.36, P < 0.05); the difference of Batra radiology score in the two groups was statistically significant (Z = 2.58, P < 0.05); the differences in the X-ray measurement of the proportion of distal radial shortening > or = 5 mm, the radial height (shortening) was statistically significant (for the correction chi2 = 7.57, P < 0.05; t = 2.016, P < 0.05); the differences of malunion rate, ulnar impaction syndrome, the incidence rate of ulnar styloid fracture nonunion of two groups was statistically significant (adjusted chi2 = 10.05, P < 0.05; chi2 = 8.39, P < 0.05; chi2 = 5.51, P < 0.05).

CONCLUSIONFor patients with surgical indications for unstable distal radius fractures, every indicator of the outcome after surgery in the treatment is better than that of the manipulative reduction and plaster fixation.