Early Versus Delayed Dynamization and Implant Removal After Kirschner Wire–Augmented External Fixation for AO/OTA Type C Distal Radius Fractures in Older Adults: An Exploratory Retrospective Cohort Study

This exploratory study aimed to compare the functional, radiological, and clinical outcomes of early and delayed dynamization and external-fixator removal protocols in older patients with AO/OTA type C distal radius fractures treated with bridging external fixation and supplemental Kirschner wires. : This retrospective comparative cohort study included 54 patients aged 60 years or older. In the early-protocol group (Group 1, n = 30), the Kirschner wires were removed and the external fixator was dynamized at postoperative week 2, followed by fixator removal at week 4. In the delayed-protocol group (Group 2, n = 24), dynamization and Kirschner-wire removal were performed at week 4, followed by fixator removal at week 6. The primary outcome was the QuickDASH score at postoperative week 12. Secondary outcomes included QuickDASH scores at weeks 18 and 24, radiographic alignment, fracture union, final clinical outcomes, and complications. Group 1 was older than Group 2 (71.7 ± 5.3 vs. 67.1 ± 4.6 years; p = 0.002). The week-12 QuickDASH score was significantly lower in Group 1 (11.9 ± 7.1 vs. 19.4 ± 8.0; p = 0.002), whereas no significant differences were observed at weeks 18 or 24. Because each treatment protocol was applied exclusively by one of the two surgeons, protocol and surgeon were completely confounded, and this comparison should be interpreted as exploratory rather than causal. A significant group-by-time interaction was identified ( p < 0.001). Loss of radial height was greater in Group 1 (0.9 ± 0.8 vs. 0.4 ± 0.5 mm; p = 0.021), while the between-group difference in increased ulnar variance did not reach statistical significance ( p = 0.060). Final radiographic parameters, union time, Mayo Wrist Score, pain, wrist range of motion, and grip strength were comparable between the groups. Two patients in Group 1 required reoperation because of loss of reduction; however, overall complication rates did not differ significantly ( p = 0.646). Earlier dynamization and external-fixator removal were associated with better functional outcomes at week 12 but greater loss of radial height, without a sustained functional advantage at weeks 18 and 24. Because the treatment protocol was completely confounded with the surgeon, these findings should be considered exploratory. The early protocol may be considered only in carefully selected patients with stable reduction and close radiographic surveillance. Not applicable.