Treatment Of Distal Radial Fractures Research Articles

Technique for Insertion of the Conventus Cage for Distal Radial Fracture Fixation.

Use of the intramedullary Conventus DRS Cage and fragment-specific screw fixation of distal radial fractures minimizes soft-tissue trauma, leading to earlier and improved wrist and finger motion while reducing traditional complications seen with internal fixation of distal radial fractures. Reduce the fracture with closed or, if necessary, open methods to achieve anatomic restoration of articular congruity, radial inclination, radial length, volar tilt, and coronal shift. Provisionally stabilize the reduced fracture for insertion of the cage and fragment-specific screws with either longitudinal finger-trap traction or longitudinal Kirschner wires. Prepare the distal part of the radius for cavity preparation and insertion of the Conventus DRS Cage. Insert the previously chosen small or large Conventus DRS Cage. Anatomically fix the fracture fragments to the cage and radial shaft. Move the wrist through a full range of motion while assessing fluoroscopically whether the fracture has been stabilized with the cage-and-screw construct. Close the skin incision and cutdown wounds and apply dressings. The Conventus DRS Cage has been used for treatment of distal radial fractures in the U.S. for >3 years.

Spanning Bridge Plate Fixation of Distal Radial Fractures.

➢ Dorsal spanning bridge plate fixation offers an option for the surgical treatment of distal radial fractures in the setting of metaphyseal bone loss or diaphyseal extension, complex injuries requiring extensive soft-tissue and osseous reconstruction, or severe osteoporosis. It is also a salvage option after distal radial nonunion.➢ Reduction is performed with use of ligamentotaxis. The plate is fixed from the radial shaft to either the second or third metacarpal, spanning the wrist joint for the duration of fracture-healing, and is removed after fracture consolidation (at approximately 3 months).➢ Surgical fixation to the second metacarpal may increase the risk of damage to the radial sensory nerve, whereas fixation to the third metacarpal may increase digital extensor tendon friction with the plate.➢ There is currently no evidence-based recommendation whether to preferentially affix the plate to the second or third metacarpal. Both options may offer advantages based on the fracture pattern.➢ The functional outcomes and complications associated with this technique are similar to those associated with other methods of fixation of distal radial fractures.

Volar Plate Fixation in Patients Older Than 70 Years with AO Type C Distal Radial Fractures: Clinical and Radiologic Outcomes.

Introduction Treatment of unstable distal radial fractures (DRFs) in elderly patients is controversial, and considering the increasing life expectancy, their appropriate treatment is of growing importance. Our aim was to analyze the clinical and radiologic outcomes in the elderly patients with AO type C DRF treated with volar locking plate (VLP). Materials and Methods Between 2007 and 2011, 572 DRFs were operated on in our hospital with open reduction and internal fixation with VLP. Of these, only 64 patients (66 DRFs) met the selection criteria (AO type C DRF, age > 70 years, minimum 12-month follow-up). Mean follow-up was 28 months. Outcome assessment included range of motion, grip strength, VAS pain, Mayo Clinic Score, and DASH score. Analysis of pre- and postoperative radiographs was performed. Complications were recorded. Statistical analysis was performed comparing the results with the contralateral side. Results Mean postoperative range of motion of the injured wrist compared with the control contralateral side was 86% for flexion ( p < 0.001), 92% for extension ( p < 0.001). The average DASH was 12. Mayo Clinic Wrist Score showed 43 excellent results, 15 good, 4 satisfactory, and 4 poor. Articular step-offs were reduced in 34 of 38 wrists. Five (7%) patients required plate removal. Conclusion The treatment of articular DRF (AO type C) with VLP in the elderly patients achieved greater than 90% of the wrist range of motion and grip strength with no residual pain in greater than 90% of the patients. Level of Evidence Therapeutic IV, case series.

Treatment of Distal Radial Fractures by Open Reduction and Internal Fixation with a Volar Locking Plate

The volar locking plate is a popular implant for surgical management of unstable distal radial fractures. We routinely utilize this system for all distal radial fractures except for those with entrapped intra-articular fragments and fractures with a displaced dorsomedial facet fracture (which is hard to capture with the volar approach alone). In this video, we describe in detail the necessary steps for successful placement of the volar locking plate, starting with preoperative planning and ending with expected outcomes. The approach that we utilize is through the flexor carpi radialis tendon sheath and avoids the radial artery. In the video, we describe 4 variations on the application of a volar locking plate: (1) the standard technique after appropriate reduction and provisional fixation with Kirschner wires, (2) regaining length through a shortened distal radial fracture, (3) using the volar plate to assist in the reduction and regain volar tilt, and (4) intraoperative management of coronal shift of the distal fragment. Complications reported for the volar locking plate have decreased with newer low-profile plate designs; however, they still include volar tendon irritation and/or rupture and median neuropathy. Postoperatively, we advise a brief 2-week period of immobilization for wound-healing, which is followed by a period during which a removable wrist splint is used and patients are instructed on the performance of a hand therapy regimen.

Recent advances in wrist trauma.

Scaphoid fractures are the most common type of carpal fractures and occur frequently in young men. Nonunion, avascular necrosis and osteoarthritis, are the complications caused by a delay in diagnosis and treatment, hence early diagnosis and treatment for such fractures are critical to achieve better outcomes [1]. The traditional clinical sign snuffbox tenderness was found no more useful in diagnosis of scaphoid fracture and authors have recommended early recourse to sophisticated imaging methods. A systematic review and meta-analysis compared the diagnostic performance of bone scintigraphy, MRI and CT for diagnosing suspected scaphoid fractures. Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture, however, MRI is more specific and better for confirming scaphoid fracture. The study emphasized the need for paired design studies or randomized controlled trials to compare CT with MRI or bone scintigraphy. Similar study presented to the ASSH reviewed 100 consecutive patients who were suspected of having a scaphoid fracture on clinical grounds despite having normal findings on initial radiographs. They concluded that magnetic resonance imaging had a better predictive value, both positive and negative and was a reliable modality for screening missed out fractures. Displaced scaphoid fractures are often treated with screw fixation. Many studies have proven that computer assisted screw placement significantly reduce radiation exposure, time, and the number of attempts for guide wire placement [2]. Dias et al concluded that on longer-term follow-up, the outcome of cast treatment of scaphoid fractures when compared with surgery showed that malunions were more common in the surgical treatment group and increased scapho-lunate angle were more likely in the casting group. Distal radial fracture is a public health concern, particularly among the elderly who often experience fragility fractures. A recent prospective study evaluating the rate of functional improvement after treatment with the volar locking plating system demonstrated similar rates of recovery between patients in two age groups (20–40 years and >60 years). The volar maintains good anatomic reduction and makes it easier for elderly patients to resume to their day-to-day activities earlier than conservative cast immobilization. However, for elderly patients with lower disutility due to mal-union and/or painful malunion one may still prefer non-operative treatment. In an another prospective randomized trial of patients with complex or unstable fractures of the distal part of the radius with one group having external and the other having internal fragment-specific fixation the conclusion was, the group with internal fixation had significantly better grip strength, wrist motion, and forearm motion with no difference in the DASH score. The long-term advantages of improved reduction after distal radial fracture remain unclear. The only available long term follow up study (33–42 years) by Forward et al. showed 68% of the patients with intra-articular fractures had posttraumatic arthritis and none had had salvage surgery [3]. Interestingly, a study revealed that most physicians with the primary designation as orthopedic surgeon still predominantly practiced closed methods for the treatment of distal radial fractures. Conversely, physicians with the primary designation as hand surgeon were much more inclined to employ internal fixation methods [4].

Assessment of Functional Outcome in Distal End Radius Fractures Managed with Locking Plates

Aim: Present study was conducted to determine the functional outcome of operative treatment of distal radial fractures with volar locking plate system in a tertiary teaching hospital. Twenty five patients were included into the study between July 2015 to January 2016. Methodology: There were 14 males and 11 females, with a mean age of 49. A total of 18 patients had fractures in dominant upper limb. 24% (6) of the fractures were type A, 12% (3) were type B, and 64%(16) were type C. They were regularly followed up. Assessment of pain, range of motion and standard radiographs were performed. The Gartland and Werley functional scores were recorded. Result: The radiographic results at the final follow-up showed a mean of 17° of radial inclination, 2.5-mm radial shortening, and mean volar tilt of 3.4° and none of them had an articular step > 2mm. An excellent or good result was obtained in 23 (92 %) patients according to the Gartland and Werley score. Overall internal fixation of distal radial fractures with a locking plate system provided a stable fixation with good clinical outcomes for patients with unstable distal end radius fractures.

Anatomic Variation in Volar Tilt of the Scaphoid and Lunate Facet of the Distal Radius

The aim of distal radial fracture treatment is to achieve optimal function through the restoration of normal anatomy, including volar tilt. The accuracy of assessing volar tilt on standard lateral radiographs compared with anatomic tilt lateral (ATL) radiographs is uncertain. This study aimed to investigate the anatomy of the articular surface of the distalradius, in particular measuring the angle between the dorsal and volar rims at severalpoints from radial to ulnar, to ascertain whether volar tilt is uniform between the scaphoid and lunate facet and to explore consistency between standard lateral and ATL views. We studied 38 dry cadaveric specimens of radii. The distal articular surface of each specimen was marked at 5 intervals and placed in a customized jig. A 1.5-mm stylus was placed at each marker to represent the articular surface angle, and was photographed in standard lateral and ATL projections. An on-screen protractor was used to measure each angle from the digital photographs. The volar tilt measurements at the lunate facet demonstrated a significantly shallower angle than those at the scaphoid facet. The measurements between the standard lateral and ATL were found to have no significant difference. Adjusting the projection angle between a simulated standard lateral and ATL view did not significantly change the volar tilt measurements in this anatomic study. The lunate facet was found to have a significantly shallower volar tilt than the scaphoid facet. Variance in radiographic volar tilt may relate to different anatomic sagittal planes, reflecting the anatomic variation between the scaphoid and lunate facets. A detailed understanding of distal radius anatomy is required by the surgeon for accurate radiologic interpretation and anatomic fracture reduction and fixation.

Distal Radial Fracture Management With an Intramedullary Cage and Fragment Fixation

To examine the outcomes associated with the treatment of distal radial fractures with an expandable intramedullary cage and fragment-specific screw fixation. A prospective multicenter case series of 100 patients with a fracture of the distal radius treated with the "Cage System" was undertaken. Primary patient outcomes included Disabilities of the Arm, Shoulder, and Hand, Patient-Related Wrist/Hand Evaluation questionnaires, and adverse events associated with the device. Secondary outcomes included wrist range of motion and radiographic findings. Follow-up was performed at intervals of 2 weeks, 4 to 6 weeks, 12 weeks, and 1 year. Ninety-one patients were available for follow-up at 2 weeks, 87 at 4 to 6 weeks, 73 at 3 months, and 61 at 12 months. The mean Disabilities of the Arm, Shoulder, and Hand score at 3 months was 21; at 12 months, it was 9. The mean total Patient-Reported Wrist/Hand Evaluation score at 3 months was 21; at 12 months, it was 11. There were 5 adverse events (5%)-2 involving radial nerve irritation and 3 involving tendon irritation from screws. Four of these 5 patients underwent surgical intervention, a neurolysis in 1 patient and removal of screws in 3. All patients were free of adverse-event symptoms at 3 months' follow-up. Wrist range of motion improved most rapidly in the first 12 weeks following surgery and continued to improve throughout follow-up. The fracture reduction achieved at surgery was maintained throughout the healing process. There was evidence of callus formation at the fracture as early as 2 weeks after surgery with 100% of fractures healed at 3 months. An expandable intramedullary cage with fragment-specific screw fixation provides maintenance of fracture reduction with a low complication rate. Therapeutic IV.

The relationship between initial closed reduction and the surgical reconstruction of the radiocarpal joint line in distal radial fractures

IntroductionWhilst initial closed reduction followed by definitive open fixation is widely applied in the treatment of distal radial fractures, the effect of the closed reduction on the reconstruction of the articular surface remains unclear. Our research questions were:(1)Does closed reduction followed by surgical fixation reconstruct palmar tilt and radial inclination?(2)Does closed reduction influence the surgically reconstructed palmar tilt and radial inclination? MethodsPalmar tilt and radiocarpal inclination of 425 patients were measured at admission, following initial closed reduction and after surgical reconstruction. ResultsClosed reduction increased palmar tilt by 12.1° and radial inclination by 2.7°. Open surgical reduction further corrected palmar tilt by 17.88° and radial inclination by 3.5°. Whilst there was no association between postoperative palmar tilt and initially achieved closed reduction, a significant association between radial inclination following closed reduction and surgical fixation was found. ConclusionOur retrospective study challenges the existence of a relationship between the initial closed reduction and the reconstruction of the anatomic joint line in surgically treated distal radial fractures.

The Effect of Isometric Massage on Global Grip Strength after Conservative Treatment of Distal Radial Fractures. Pilot Study.

The most common fracture of the distal end of the radius is Colles' fracture. Treatment modalities available for use in hand rehabilitation after injury include massage. The aim of this study was to evaluate the effect of isometric massage on the recovery of hand function in patients with Colles fractures. For this purpose, the strength of the finger flexors was assessed as an objective criterion for the evaluation of hand function. The study involved 40 patients, randomly divided into Group A of 20 patients and Group B of 20 patients. All patients received physical therapy and exercised individually with a physiotherapist. Isometric massage was additionally used in Group A. Global grip strength was assessed using a pneumatic force meter on the first and last day of therapy. Statistical analysis was performed using STATISTICA. Statistical significance was defined as a P value of less than 0.05. In both groups, global grip strength increased significantly after the therapy. There was no statistically significant difference between the groups. The men and women in both groups equally improved grip strength. A statistically significant difference was demonstrated between younger and older patients, with younger patients achieving greater gains in global grip strength in both groups. The incorporation of isometric massage in the rehabilitation plan of patients after a distal radial fracture did not significantly contribute to faster recovery of hand function or improve their quality of life.

Factors Associated with One-Year Outcome after Distal Radial Fracture Treatment

Authors’ reply We agree that bone models are useful alternatives to cadavers for testing the strength of surgical fixation. The polyurethane foam models have similar mechanical properties to osteoporotic cancellous bone, with little inter-specimen variability (Fig.). The Synbone model used in our study was an older model. The nearest equivalent in the current Synbone catalogue would be model number 2422.

Factors associated with one-year outcome after distal radial fracture treatment.

To identify factors that affect functional outcome one year after distal radial fracture treatment. 521 women and 121 men aged 16 to 92 (mean, 59) years with distal radial fractures underwent external fixation (n=123), open reduction and internal fixation (n=63), a combination of both (n=10), distal radial osteotomy for symptomatic malunion (n=90), or casting with (n=194) or without (n=162) prior closed manipulation under regional anaesthesia. The indication for surgery (rather than casting) was metaphyseal instability. Radiographic evaluation (dorsal angulation, radial shortening, carpal malalignment, and malunion) was made before and after treatment and after fracture healing. Functional evaluation (range of movement, grip strength, and activities of daily living) was made at a mean of 16 (range, 6-54) months after injury. After multiple regression analysis, poorer functional score was associated with increasing age (p<0.001), dorsal angulation after healing (p<0.016), presence of volar comminution (p=0.005), and pain (p<0.001). Poorer grip strength was associated with non-dominant side injury, increasing age, dorsal angulation after healing, positive ulnar variance, comminution, and pain (all p<0.001). Predicted malunion showed colinearity with age (r=0.657), dorsal comminution (r=0.694), and dorsal angulation (r=0.626). Understanding factors associated with outcome helps surgeons to make the treatment decision for distal radial fracture to achieve optimum outcome.

Volar locking compression plate combined with artificial bone grafting for treatment of comminuted distal radial fracture

Objective To investigate the clinical results of the application of volar locking compression plate combined with artificial bone grafting in the treatment of comminuted distal radial fractures.Methods From January 2011 to August 2013,45 cases of type A3,type C2 and type C3 comminuted distal radial fractures were treated with volar locking compression plate combined with artificial bone grafting.All the cases were closed fractures with radial shortening or articular surface collapse.Volar tilt angle,radial inclination angle,axial shortening of the radius and extent of joint surface step deformity were measured both pre and post operatively.Results All the patients were follow-up for 6 to 18 months,with an average of 12 months.Bone union was noted in all the cases.There was no adverse reaction to the artificial bone grafts.Radiographic parameters were significantly improved.The clinical results were evaluated using the Gartland-Werley wrist score and rated as excellent and good in 94.4％ of type A3 fractures,87.5％ of type C2 fractures,and 81.8％ of type C3 fractures.Conclusion Applying volar locking compression plate combined with artificial bone grafting can achieve rigid fixation and restore radial length in treating type A3,C2 and C3 comminuted distal radial fractures. Key words: Radius fractures; Fracture fixation, internal; Artificial bone

English

BACKGROUND AND OBJECTIVE: The Irish surgeon Abraham Colles described DRFs (distal radial fractures) in the 1814 volume of the Edinburgh Medical Surgical Journal. Although his description was based on clinical examination alone (because radiography had not yet been invented), it is quite accurate, and it is Colles's name that is most often associated with this fracture in the English-speaking world. Colles stated, One consolation only remains, that the limb will at some remote period again enjoy perfect freedom in all of its motions and be completely exempt from pain. This claim that all DRFs, despite displacement, will fare well has been a source of criticism. Incidence of fractures of distal radius are increasing due to more geriatric population and road traffic accidents and at the same time surgical treatment option for the same are modified continuously. The fundamental goal treatment of distal radial fractures is restoration of normal or near normal alignment and articular congruity. A recent trend in internal fixation has been a move towards locking screw implants which can rigidly stabilize cancellous fragmented bone that is normally not amenable to screw fixation. RESULT: The study comprised of 15 male and 5 female patients aged from 22 to 70 years with mean age of 42.82 years. The average duration from date of injury to date of surgery was 2.35 days. The follow up ranged from 9 to 18 months. Using the demerit scoring system of Gartland and Werley we had 50% excellent 40% good, 10% fair and 0 poor results. INTERPRETATION AND CONCLUSION: Open reduction and internal fixation of distal radius fracture with volar locking compression plate provides stable fixation, can restore articular congruity and results in good to excellent functional outcome with minimal complication.

Distal radial fractures

The rate of operative treatment of distal radial fractures has risen significantly over the past 2 decades. Technological advancements in plating options have contributed to this trend. Volar locking plates have rapidly gained popularity as the technique of choice, but recent literature suggests that volar locking plates only provide short-term benefit with faster recovery of function but equivalent clinical results at 1 yr when compared with external fixation and pins. Volar locking plates do result in improved radiographic results, so longer-term studies are needed for further analysis. Dorsal plating provides improved exposure of the articular surface, and newer generation low-profile dorsal plates have lower tendon-related complication rates. Dorsal spanning plates often are used in polytrauma patients with severe intraarticular fractures to restore length and alignment while facilitating immediate unrestricted use of the hand. Fragment-specific fixation uses customizable implants to assist with anatomic reduction of multifragmented, intraarticular fractures of the distal radius. Here, we provide an overview of literature published from 2013–2014 concerning volar, dorsal, fragment-specific, and spanning plate fixation, complications, and technological updates for the surgical treatment of distal radial fractures.

Quality of life after volar locked plating: a 10-year follow-up study of patients with intra-articular distal radius fractures.

BackgroundThis study aimed to present functional results and patient’s health related quality of life (HRQOL) data ten years after volar locked plate fixation (VPF) of unstable intra-articular distal radial fractures (DRF).MethodsThirty-nine patients with a mean age of sixty-one years were operatively treated with VPF after intra-articular distal radial fractures. They were evaluated two, six, and ten years postoperatively according to the Gartland and Werley score. For subjective evaluation the Short Form 36 (SF-36) and the Disability of Arm, Shoulder and Hand (DASH) questionnaires were adopted.ResultsOverall, wrist function did not differ significantly two, six and ten years after the operation. Over 90% patients achieved “good” or “excellent” results ten years after surgery according to the Gartland and Werley score. Ten years postoperatively the results of the SF 36 did not differ significantly from the two- and six-year follow-up. Overall findings from the SF-36 did not differ significantly from the data of Austrian and American norm populations. Only in the subscale of mental health (MH) the ten-year follow-up did show significantly poorer results (p = 0.045) compared to the Austrian norm population. The median DASH scores did not show significant differences during the ten-year follow-up period.ConclusionThe ten-year results of this single-center study suggest that operative treatment of intra-articular DRF with volar locked plates is a useful and satisfactory therapy option, both in terms of function and HRQOL.

Minimally invasive plate osteosynthesis for distal radius fractures

Background:Fractures of distal radius are common injury in all age groups. Cast treatment with or without close reduction is a viable option. However, the results are often unsatisfactory with restricted function. The open reduction and internal fixation often results in extensive soft tissue dissection and associated high rates of infect and delayed/nonunion. The distractor/external fixator have reported good functional and anatomical results but the incidence of pin traction infection nerve injury and cosmedic deformity are high. We introduced a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for distal radial fracture and evaluated the functional outcomes and complications.Materials and Methods:22 distal radial fractures (10 left, 12 right) were treated using the MIPO technique and two small incisions with a palmar locking plate from August 2009 to August 2010. The wrist function was assessed according to Dienst wrist rating system, and postoperative complications were recorded.Results:According to Dienst wrist rating system, 13 patients showed excellent results, 6 cases showed good results and 3 patients had moderate results. No patient had poor results. Thus, the excellent and good rate was 86.4%. One patient had anesthesia in the thenar eminence and this symptom disappeared after 3 months. One patient had delayed healing in the proximal wrist crease. Two patients had mild pain on the ulnar side of the wrist and two patients had limited wrist joint function.Conclusion:The MIPO technique by using two small palmar incisions is safe and effective for treatment of distal radial fractures.

Study protocol: non-displaced distal radial fractures in adult patients: three weeks vs. five weeks of cast immobilization: a randomized trial

BackgroundUp to 30% of patients suffer from long-term functional restrictions following conservative treatment of distal radius fractures. Whether duration of cast immobilisation influences functional outcome remains unclear.Methods/DesignThe aim of the study is to evaluate whether the duration of immobilization of non or minimally displaced distal radial fractures can be safely reduced. We will compare three weeks of plaster cast immobilization with five weeks of plaster cast immobilization in adult patient with non or minimally displaced distal radial fractures.Study design: a prospective randomized clinical trial.Study population: adult (>18 years) (independent in activities of daily living) patients with a non/minimal displaced distal radius fracture (dorsal angulation <15°, volar tilt <20°, radial inclination >15°, ulnar positive variance <5 mm and an articular step off <2 mm).Intervention: three weeks of plaster cast immobilization versus five weeks of plaster cast immobilization.Main study parameters: primary outcome parameters: Patient related wrist evaluation (PRWE) Quick Disability of Arm, Shoulder and Hand (QUICKDASH) score after a one year follow-up, and secondary parameters: range of motion, pain level (VAS) and complications.DiscussionThe expectation of this study is that shorter duration of plaster cast immobilisation is beneficial for the patient with a distal radius fracture. This risk of specific complications is low and generally similar in both treatment options. Moreover, the burden of the study is not much higher compared to standard treatment. Follow-up is standardized according to current trauma guidelines. Literature indicates that both treatment options from the study are accepted for displaced distal radius fractures. No clear advantage for one treatment options is found at present in the literature, although there is no level I evidence present. This trial will provide level-1 evidence for the comparison of consolidation and functional outcome between two treatment options for non-displaced distal radial fractures. The gathered data may support the development of a clinical guideline for conservative treatment of distal radial fractures.Trial registrationNetherlands National Trial Register NTR3552.

Complications following volar locking plate fixation for distal radial fractures: a systematic review

The purpose of this systematic review is to assess the prevalence of complications following volar locking plate fixation of distal radial fractures. A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Only prospective comparative and prospective cohort studies that presented data concerning complications after treatment of distal radial fractures with a volar locking plate in human adults with a minimal follow-up of 6 months were included. Two quality assessment tools were used to assess the methodological quality of the studies (level of evidence rating according to the Oxford Centre of Evidence Based Medicine and the modified version of the Cochrane Bone, Joint and Muscle Trauma Group's former quality assessment tool). Thirty three studies were eligible for final assessment. Most complications were problems with nerve and tendon function as well as complex regional pain syndrome. With an overall complication rate of 16.5%, most of which were 'minor' complications and low rates of nonunion and malunion, volar locking plate fixation can be considered a reasonably safe treatment option for patients with distal radial fractures.

Surgical Treatment of Distal Radial Fractures with a Volar Locking Plate Versus Conventional Percutaneous Methods

The aim of this study was to compare the outcomes of displaced distal radial fractures treated with a volar locking plate with the results of such fractures treated with a conventional method of closed reduction and percutaneous wire fixation with supplemental bridging external fixation when required. Our aim was to ascertain whether the use of a volar locking plate improves functional outcomes. A single-center, pragmatic, randomized controlled trial was conducted in a tertiary care institution. One hundred and thirty patients (eighteen to seventy-three years of age) who had a displaced distal radial fracture were randomized to treatment with either a volar locking plate (n = 66) or a conventional percutaneous fixation method (n = 64). Outcome assessments were conducted at six weeks, twelve weeks, and one year. Outcomes were measured on the basis of scores on the Patient Evaluation Measure (PEM) and QuickDASH questionnaire (a shortened version of the Disabilities of the Arm, Shoulder and Hand, or DASH, Outcome Measure), EuroQol-5D (EQ-5D) scores, wrist range of motion, grip strength, and radiographic parameters. The rate of follow-up at one year was 95%. Patients in the volar locking-plate group had significantly better PEM and QuickDASH scores and range of motion at six weeks compared with patients in the conventional-treatment group, but there were no significant differences between the two groups at twelve weeks or one year. Grip strength was better in the plate group at all time points. The volar locking plate was better at restoring palmar tilt and radial height. Significantly more patients in the plate group were driving at the end of six weeks, but this did not translate to a significant difference between groups in terms of those returning to work by that time. Use of a volar locking plate resulted in a faster early recovery of function compared with use of conventional methods. However, no functional advantage was demonstrated at or beyond twelve weeks. Use of the volar locking plate resulted in better anatomical reduction and grip strength, but there was no significant difference in function between the groups at twelve weeks or one year. The earlier recovery of function may be of advantage to some patients. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.