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A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures

  • Authors:
    • Jingqiao Li
    • Yipeng Yang
    • Xu Zhang
    • Dandan Zhang
    • Yadong Yu
    • Rong Chen
    • Wei Du
  • View Affiliations / Copyright

    Affiliations: Department of Orthopedics, Jingxing County Hospital, Shijiazhuang, Hebei 050300, P.R. China, Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China, Department of Reproduction and Genetics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China, Department of Neurology, Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio‑cerebrovascular Disease, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
    Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 14
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    Published online on: October 30, 2025
       https://doi.org/10.3892/etm.2025.13009
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Abstract

Distal radius fractures are common injuries in older adult patients. The present prospective study aimed to compare the efficacies of bridging external fixation (BEF) and combined external fixation (CEF) in preventing radial height loss in older patients with distal radius fractures. Between January 2018 and December 2022, a total of 118 patients with distal radius fractures, aged 55‑70 years, were randomly subjected to either BEF or CEF. Standard radiographs were used to measure radiological parameters, including radial height, palmar tilt, radial inclination, ulnar variance, articular step‑off and Lidström classification. All patients were examined for active range of motion, grip strength, supination torque, level of pain during specified activities with a numeric rating scale, modified Mayo Wrist Score, Disabilities of the Arm Shoulder and Hand score, Patient‑Rated Wrist Evaluation score and patient satisfaction. The patient characteristics showed significant differences in terms of operative time (t=12.52; P<0.01), successful closed reduction (χ2=32.74; P<0.01), change to open surgery (χ2=32.74; P<0.01) and cost (t=4,585.26; P<0.01). The t‑tests showed significant differences (P<0.01) in the radiological parameters of intraoperative closed reduction between the two groups. By contrast, no significant differences (P>0.05) were observed in the radiological parameters between bone healing and final follow‑up within each group, and in the radiological parameters of bone healing and final follow‑up between the two groups. Lidström classification showed significant differences between bone healing and final follow‑up within the BEF group (χ2=5.96; P<0.05) and the CEF group (χ2=8.18; P<0.01), but no significant differences at the time of bone healing (χ2=3.57; P=0.06) and final follow‑up (P=0.12) between the two groups. Furthermore, the t‑tests showed no significant differences (P>0.05) in the functional and clinical outcomes between the two groups at the final follow‑up. In conclusion, CEF may be as effective as BEF in preventing radial height loss in older patients with distal radius fractures. Percutaneous bony distraction may be more effective than conventional distraction manoeuvres in achieving anatomical reduction with minor morbidity. The two techniques demonstrate a similar ability for bone remodeling. Further studies on the therapeutic advantages of CEF over BEF are warranted, especially considering its lower cost compared with BEF. 
View Figures

Figure 1

Flow diagram showing bridging external
fixation and combined external fixation for distal radius
fractures.

Figure 2

Imaging results of a 62-year-old
female patient who suffered a type C3 distal radius fracture in the
left wrist. (A) Posteroanterior X-ray showing comminuted fracture
with compression of the distal radius. (B) Lateral X-ray
demonstrating an intra-articular fracture and anterior
displacement. (C) Coronal CT plane showing an intra-articular
fracture. (D) Sagittal CT plane image. CT, computed tomography.

Figure 3

Consolidated Standards of Reporting
Trials flow diagram of 147 patients (147 distal radius
fractures).

Figure 4

Intraoperative images of the same
patient as in Fig. 2. (A) Two
2.5-mm Steinmann pins were placed into the second metacarpal and
the proximal fragment of the radius, respectively. (B) A reduction
pin (indicated by the aterisk) was placed across the fracture site
and bony destruction power (arrow) was applied to the pin. (C) An
oblique pin (arrow) was inserted from the radial styloid across the
fracture line, with intraoperative fluoroscopy showing improved
alignment. However, continuous distraction was maintained until the
bone cement solidified. (D) A volar view showing that combined
fixation (BEF and non-BEF) was complete. (E) Dorsal view. BEF,
bridging external fixation.

Figure 5

Intraoperative imaging of the same
patient as in Fig. 2. (A)
Posteroanterior X-ray showing reduction and combined external
fixation. (B) Lateral view. (C) Bone healing after 3 months. (D)
Lateral view.

Figure 6

Follow-up of the patient from Fig. 2 after 2 years. (A) Ulnar deviation.
(B) Radial deviation. (C) Extension. (D) Flexion. (E) Pronation.
(F) Supernation.

Figure 7

Imaging results of a 64-year-old
female patient who suffered a type A3 distal radius fracture in the
right wrist. (A) Posteroanterior X-ray showing an extra-articular
fracture with lateral displacement. (B) Lateral X-ray showing
anterior displacement. (C) Sagittal CT plane image. CT, computed
tomography.

Figure 8

Completed combined external fixation
in the same patient as in Fig. 7.
(A) Volar view. (B) Dorsal view. (C) Posteroanterior X-ray. (D)
Oblique X-ray. (E) Reverse oblique X-ray.

Figure 9

Bone healing after 6 weeks in the same
patient as in Fig. 7. (A)
Posteroanterior X-ray. (B) Lateral X-ray.
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Copy and paste a formatted citation
Spandidos Publications style
Li J, Yang Y, Zhang X, Zhang D, Yu Y, Chen R and Du W: A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures. Exp Ther Med 31: 14, 2026.
APA
Li, J., Yang, Y., Zhang, X., Zhang, D., Yu, Y., Chen, R., & Du, W. (2026). A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures. Experimental and Therapeutic Medicine, 31, 14. https://doi.org/10.3892/etm.2025.13009
MLA
Li, J., Yang, Y., Zhang, X., Zhang, D., Yu, Y., Chen, R., Du, W."A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures". Experimental and Therapeutic Medicine 31.1 (2026): 14.
Chicago
Li, J., Yang, Y., Zhang, X., Zhang, D., Yu, Y., Chen, R., Du, W."A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures". Experimental and Therapeutic Medicine 31, no. 1 (2026): 14. https://doi.org/10.3892/etm.2025.13009
Copy and paste a formatted citation
x
Spandidos Publications style
Li J, Yang Y, Zhang X, Zhang D, Yu Y, Chen R and Du W: A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures. Exp Ther Med 31: 14, 2026.
APA
Li, J., Yang, Y., Zhang, X., Zhang, D., Yu, Y., Chen, R., & Du, W. (2026). A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures. Experimental and Therapeutic Medicine, 31, 14. https://doi.org/10.3892/etm.2025.13009
MLA
Li, J., Yang, Y., Zhang, X., Zhang, D., Yu, Y., Chen, R., Du, W."A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures". Experimental and Therapeutic Medicine 31.1 (2026): 14.
Chicago
Li, J., Yang, Y., Zhang, X., Zhang, D., Yu, Y., Chen, R., Du, W."A comparison of bridging external fixation vs. combined external fixation for preventing radial height loss in older patients with distal radius fractures". Experimental and Therapeutic Medicine 31, no. 1 (2026): 14. https://doi.org/10.3892/etm.2025.13009
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