Surgical Treatment of Distal Radial Fractures with a Volar Locking Plate Versus Conventional Percutaneous Methods: A Randomized Controlled Trial

• Published in: Journal of bone and joint surgery. American volume 2013-10, Vol.95 (19), p.1737-1744
• Main Authors: Karantana, Alexia, Downing, Nicholas D, Forward, Daren P, Hatton, Mark, Taylor, Andrew M, Scammell, Brigitte E, Moran, Chris G, Davis, Tim R.C
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Bone Plates; Device Removal - statistics & numerical data; Disabled Persons - statistics & numerical data; Female; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Male; Middle Aged; Patient Satisfaction; Postoperative Complications - etiology; Quality of Life; Radiography; Radius Fractures - diagnostic imaging; Radius Fractures - physiopathology; Radius Fractures - surgery; Range of Motion, Articular - physiology; Reoperation - statistics & numerical data; Treatment Outcome; Young Adult
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.L.00232

BACKGROUND: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. METHODS: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. RESULTS: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. CONCLUSIONS: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. LEVEL OF EVIDENCE:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.