الفهرس 
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Abstract
Distal radius fractures are the most common upper extremity fracture, representing up to 16% of all fractures seen in the emergency department. It affecte young patients following high-energy trauma and elderly patients with osteoporotic bone following low-energy falls.
The surgical indications for distal radius fractures generally include displaced or unstable fracture patterns. The goal of treatment is to restore congruity to the radiocarpal and distal radioulnar joint surfaces and to restore and maintain the length of the radius.
Management for simple fractures includes closed reduction and casting, closed reduction and percutaneous fixation, and open reduction internal fixation with volar or dorsal plating. However, highly comminuted fractures may not be amenable to open reduction internal fixation with volar or dorsal plating.
Many surgical techniques are used to fix unstable distal radius fractures including percutaneous pinning, external fixation, and plate fixation.
External fixation is a well-accepted orthopedic principle that uses an external bar as a bridging stru across a fracture to maintain its length and position. The bar is connected to the 2 fracture fragments through metal pins that are placed percutaneously or through limited incisions and that protrude through the skin.
Despite the reported success of external fixation for the treatment of distal radius fractures, a review of the literature shows several problems. The most common complications are related to the metal pins used for fixation and include pin track infections, pin loosening, osteomyelitis, soft-tissue scarring and skin necrosis at pin sites and injury to the superficial sensory branch of the radial nerve as a result of improper pin placement.
The dorsal spanning plate is an excellent option in the treatment of high-energy fractures and patients with polytrauma, fractures with dorsal or volar comminution, and fracture dislocations, and in geriatric patients with poor bone quality. The dorsal spanning plate not only allows for fixation of these complex fractures but also allows for weight-bearing through the wrist, an advantage for patients with concomitant lower extremity fractures and geriatric patients who need mobility aides.
The study is aimed to compare treatment outcomes of Spanning plate versus spanning External fixator in fixation of comminuted distal radius fracture.
This is a Prospective study, was conducted at Orthopedic & traumatology Department, Sohag University hospital, from April 2021 till April 2022.
The main results of the study revealed that:
The mean age among group 1 was 48.9± 15.3 while among group 2 was 47.4± 10.4. There was no statistically significant difference between two groups regarding age. There were 73.3% males and 26.7% females among group 1 while there was 66.7% males and 33.3% females among group 2. There was no statistically significant difference between the two groups regarding gender.
There were 20% had DM and 80% had no DM among group 1 while there were 40% had DM and 60% had no DM among group 2. There was no statistically significant difference between the two studied groups regarding DM. According to smoking there were 33.3% smokers and 66.7 non-smokers among group 1 while there were 26.7% smokers and 73.3% non-smokers among group2.There was no statistically significant difference between the two studied groups regarding smoking status.
there were 66.7% had affected dominant side and 33.3% had affected non-dominant side among group 1 while there were 53.3% had affected dominant side and 46.7% had affected non-dominant side among group 2. There was no statistically significant difference between the two studied groups regarding affected side.
There were 26.7% open fracture and 73.3% closed fracture among group 1 while there were 7.1% open fracture and 92.9% closed fracture among group 2. There was no statistically significant difference between the two studied groups regarding type of fracture. According to fracture dislocation there were 26.7% had fracture dislocation among group 1 while 21.4% had fracture dislocation among group 2. There was no statistically significant difference between the two studied groups regarding dislocation.
The mean follow-up period was 10.6± 2.1 among group 1 while it was 11.1± 2.5 among group 2. There was no statistically significant difference between the two studied groups regarding follow-up period.
The mean mayo score was 58.3± 13.2 among group 1 while it was 58.7± 12.2 among group 2. There was no statistically significant difference between the two studied groups regarding Mayo score.
There was statistically significant difference between the two studied groups regarding VAS score as it was higher among group 2. There was statistically significant difference between the two studied groups regarding ulnar and radial deviation as there were higher among group 2.
Among group 1 there were 20% had pain and 80% had no complications while among group 2 there were 20% had wound infection, 6.7% had pain and 73.3% had no complications. There was no statistically significant difference between the two studied groups regarding complications.
There was statistically significant difference between the two studied groups regarding the satisfaction score.
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.
Conclusion
Spanning plate is more effective than spanning External fixator as there was statistically significant difference between the two studied groups regarding VAS score as it was higher among group 2. There was statistically significant difference between the two studied groups regarding ulnar and radial deviation as there were higher among group 2. The satisfaction score was higher among group 2.
Recommendations
Further studies on large geographical scale and on larger sample size to emphasize our conclusion.
More patients, longer follow-up, and multicenter experience are all necessary to accurately figure out treatment outcomes of Spanning plate versus spanning External fixator in fixation of comminuted distal radius fracture.
Further study is necessary to determine long-term functional outcomes with this technique and to evaluate the optimal method of fixation for these challenging injuries.