Volar Internal Plate Fixation Versus Plaster in Displaced Extra-articular Distal Radius Fractures: A Randomized Controlled Trial

Abstract

There is no financial information to disclose. Despite the high incidence of displaced extra-articular distal radius fractures and the substantial implications of suboptimal management, it is still unknown how these fractures should be treated. The recent years there is a trend towards open reduction and internal fixation (ORIF). However adequate randomized controlled trials addressing this topic in young adults are lacking. The purpose of this randomized controlled trial was to compare the functional outcome of open reduction and volar plate fixation versus plaster immobilization in displaced extra-articular distal radius fractures. A prospective randomized controlled trial in patients from 18 to 75 years with an adequate reduced extra-articular distal radius fracture (AO type A2/3) was performed. The primary outcome was the functional outcome measured with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire after 12 months. Secondary outcomes were functional outcome measured with the Patient-Rated Wrist Evaluation (PRWE) questionnaire, quality of life measured with the Short Form-36 (SF-36) health questionnaire, range of motion, grip strength, pain as measured on a Visual Analogue Scale (VAS), radiographic measurements, and complications. Follow-up took place at the outpatient clinic at 1, 2/3 and 6 weeks, and at 3, 6 and 12 months. A total of 90 patients were randomized to ORIF with a volar plate (47 patients) or plaster immobilization (43 patients). The median age was 59 years (IQR 46 – 65). Of all patients 74% were women. Median DASH scores were significantly lower in the operative group at 6 weeks (P < 0.001), and 3 (P < 0.001), 6 (P = 0.003) and 12 months (P = 0.011). The same applied for the PRWE scores and the physical component score on the SF-36. At 12 months, radial deviation, pronation, supination, dorsiflexion, palmar flexion, and grip strength were significantly lower in the non-operative group compared to the operative group. Moreover, VAS pain scores were significantly higher in the non-operative group till 3 months of follow-up (P < 0.001). After 12 months, radiological parameters were significantly worse in the non-operative group compared to the operative group. Twelve patients (28%) of the non-operative treated group had a redislocation within 6 weeks, requiring ORIF, and six patients (14%) had a symptomatic malunion for which a corrective osteotomy was performed. (Figs. 11-1, 11-2) •Displaced extra-articular distal radius fractures treated operatively have better functional outcomes as measured by the DASH and PRWE questionnaire.•42% of the initially non-operatively treated patients, should secondarily be treated operatively due to a redislocation or a symptomatic malunion.Figure 11-2DASH scores during follow-up.View Large Image Figure ViewerDownload Hi-res image Download (PPT)