External Fixation versus Volar Plate Fixation for Unstable Distal Radial Fractures - A 3-year Follow-up of a Randomized Controlled Trial

Abstract

There is no financial information to disclose. To determine if volar locking plate (VLP) is superior to external fixation (EF) 3 years after surgery for unstable dorsally displaced distal radial fractures in patients 50-74 years of age after low energetic injury. During 2009-2013, 140 patients with unstable distal radial fractures were randomized to either VLP or EF with or without adjuvant pins. 118 patients (EF; 56, VLP; 62) were available for a 3 year follow up. Primary outcome was DASH. Secondary outcome variables were PRWE, EQ-5D, ROM, grip strength, radiological signs of arthrosis and complications to surgery. The intention to treat principle was used for all statistical calculations. There were no clinically or statistically significant differences regarding DASH, PRWE, EQ-5D, ROM and grip strength. The reoperation rate was 21% (13/62) in the VLP group compared to 13% (7/56) in the EF group. The arthrosis rate was 32% (19/59) in the VLP group compared to 21% (11/53) in the EF group. (Tables 58-1, 58-2) •The clinical result was equal after VLP compared to EF 3 years after surgery for dorsally displaced unstable distal radial fractures in patients 50-74 years of age after low energetic injury.•VLP caused more reoperations due to complications compared to EF.•The arhtrosis rate was higher after VLP compared to EF.Table 58-1DASH, PRWE, and EQ-5D in Patients Treated for Unstable Dorsally Displaced Distal Radial with External Fixation (EF) or Volar Locking Plate (VLP) Presented as Mean : Median (SD)(range)EF (n = 56)VLP (n = 62)P valueDASH7.0 : 2.5 (9.9) (0-52)5.4 : 2.5 (7.1) (0-40)0.724 (Mann-W)PRWE6.6 : 1.5 (12) (0-71)6.1 : 1.8 (9.2) (0-42)0.546 (Mann-W)EQ-5D0.92 : 1.0 (0.13) (0.35-1)0.92 : 1.0 (0.13) (0.41-1)0.860 (Mann-W) Open table in a new tab Table 58-2Secondary Surgery in Patients with Unstable Dorsally Displaced Distal Radial Fractures Treated with External Fixation (EF) or Volar Locking Plate (VLP)ComplicationEF (n = 56)VLP (n = 62)Fixation failure2 (1 also later plate extraction)2 (1 also later plate extraction)Plate extraction Tenosynovitis28 CRPS01 Other02Compartment syndrome01 (also later plate extraction)Carpal tunnel syndrome11 (also later plate extraction)Deep infection10Scar correction20Extensor tendon rupture01Total8∗One patient had 2 secondary surgeries at separate occasions – refixation due to fixation failure and later plate extraction16#Three patients had 2 secondary surgeries at separate occasions – 1 had refixation due to fixation failure and later plate extraction, 1 had fasciotomy due to compartment syndrome and later plate extraction, and 1 had carpal ligament release due to carpal tunnel syndrome and later plate extraction∗ One patient had 2 secondary surgeries at separate occasions – refixation due to fixation failure and later plate extraction# Three patients had 2 secondary surgeries at separate occasions – 1 had refixation due to fixation failure and later plate extraction, 1 had fasciotomy due to compartment syndrome and later plate extraction, and 1 had carpal ligament release due to carpal tunnel syndrome and later plate extraction Open table in a new tab