Session XII - Upper Extremity

Sat., 10/7/06 Upper Extremity, Paper #72, 4:00 pm

Volar Locked Plating Versus Bridging External Fixation for Unstable Distal Radial Fractures (OTA 23): A Randomized Prospective Trial

Kenneth A. Egol, MD (n); Michael Walsh, PhD (n); Toni McLaurin, MD (n);
Nirmal C. Tejwani, MD (e-Zimmer, EBI); Katherine Rosenblatt (n); Nader Paksima, DO (n);
NYU-Hospital for Joint Diseases, New York, New York, USA

Purpose: No treatment for unstable distal radius fractures is universally accepted. The purpose of this study was to compare two treatment methods for fixation of operative distal radius fractures with regard to functional outcome, radiographic outcome, and complication rate.

Methods: All patients presented to our institution with a distal radius fracture were enrolled in a prospective database that included baseline demographic data, injury, and treatment information. Patients who required surgery and met the inclusion criteria were then randomized to receive either a volar locked plate or bridging external fixation with supplemental K-wire fixation as treatment for their injury. Operative data were collected and the patients were followed at 2, 6, 12, 24, and 52 weeks. At each follow-up, detailed examination included wrist and finger range of motion as well as functional outcome in the form of the DASH scores. Radiographic outcome was assessed at each visit with regard to fracture union, loss of reduction, and development of arthritis.

Results: Over a 3-year period, 280 distal radius fractures presented to our institution. 80 patients who met the inclusion criteria were randomized. Demographics for the external fixation (ex-fix) group and plate group were similar with regard to age, sex, hand dominance, fracture pattern, socioeconomic status, and number of pre-existing medical conditions. Based on the measure of work function, the plate group had lower DASH scores at 6 months and 1 year (all P = 0.01). Radiographically, the plate group maintained reduction to a greater degree than the ex-fix group. Both the radial inclination (P = 0.04) and the ulnar variance (P =0.02) were better in the plate group at 6 months with no change at 1 year. Wrist flexion (P = 0.02) and pronation (P = 0.05) were both significantly better in the plate group at 6 months. The complication rate was similar in both treatment methods. These trends were continued at 1 year.

Conclusion/Significance: Our results suggest both improved functional and radiographic outcomes with the use of a volar locked plate for the treatment of unstable distal radius fractures that require operative stabilization at all time points.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.