Abstract
Background and purpose — There is no consensus regarding optimal treatment of displaced distal radius fractures (DRFs). We compared the results of 2 treatment protocols: early palmar plating vs. primary nonoperative treatment of displaced DRFs.Patients and methods — We performed a prospective randomized controlled study including 80 patients aged ≥ 50 years with dorsally displaced DRFs, excluding AO type C3 fractures. Patients were randomized to undergo either immediate surgery with palmar plating (n = 38), or initial nonoperative treatment (n = 42) after successful closed reduction in both groups. Delayed surgery was performed in nonoperatively treated patients showing early loss of alignment (n = 16). The primary outcome measure was Disabilities of the Arm, Shoulder, and Hand (DASH) score.Results — Mean DASH scores at 24 months in the early surgery group were 7.9 vs. 14 in the initial nonoperative group (difference between means 6, 95% CI 0.1–11, p = 0.05). Delayed operation was performed on 16/42 of patients due to secondary displacement in the initial nonoperative group. In “as treated” analysis, DASH scores were 7 in the early surgery group, 13 in the nonoperative group, and 17 after delayed surgery (p = 0.02). The difference in DASH scores between early and delayed surgery was 9 points (CI 0.3–19, p = 0.02)Interpretation — Treatment of DRFs with early palmar plating resulted in better 2-year functional outcomes for ≥50-year-old patients compared with a primary nonoperative treatment protocol. Delayed surgery in case of secondary displacement was not beneficial in terms of function.
Highlights
Patients and methods — We performed a prospective randomized controlled study including 80 patients aged ≥ 50 years with dorsally displaced distal radius fractures (DRFs), excluding AO type C3 fractures
We compared the results of 2 treatment protocols: early palmar plating vs. primary nonoperative treatment of displaced DRFs
Interpretation — Treatment of DRFs with early palmar plating resulted in better 2-year functional outcomes for ≥ 50-year-old patients compared with a primary nonoperative treatment protocol
Summary
Patients and methods — We performed a prospective randomized controlled study including 80 patients aged ≥ 50 years with dorsally displaced DRFs, excluding AO type C3 fractures. Mean DASH scores at 24 months in the early surgery group were 7.9 vs 14 in the initial nonoperative group (difference between means 6, 95% CI 0.1–11, p = 0.05). Interpretation — Treatment of DRFs with early palmar plating resulted in better 2-year functional outcomes for ≥ 50-year-old patients compared with a primary nonoperative treatment protocol. Percutaneous Kirschner wire (K-wire) fixation and ORIF with palmar plating are the most used fixation methods of displaced DRFs. The previous DRAFFT study showed no difference in functional results at 12 months between percutaneous K-wire fixation and volar plating in adults (Costa et al 2014). A recent study of Martinez-Mendez et al (2018) showed significantly better functional results in patients older than 60 years treated with palmar plating compared with cast treatment of DRF
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
