Sat., 10/18/08 Upper Extremity, Paper #70, 4:22 pm OTA-2008
A Prospective, Randomized Clinical Trial on Unstable Distal Radius Fractures: External Fixation, Radial Column Plating, and Volar Plating
David H. Wei, MSc1 (n); Noah M. Raizman, MD2 (n); Clement J. Bottino, MD1 (n);
Charles M. Jobin, MD1 (n); Robert J. Strauch, MD1 (n); Melvin P. Rosenwasser, MD1 (n);
1New York Presbyterian Hospital, Department of Orthopaedic Surgery, Columbia College of
Physicians and Surgeons, The Trauma Training Center, New York, New York, USA;
2George Washington University School of Medicine, Department of Orthopaedic Surgery,
Washington, District of Columbia, USA
Purpose: Optimal surgical management of unstable distal radius fractures is controversial. External fixation and locked volar plating demonstrate excellent clinical results, but evidence from rigorous comparative trials is rare. Additionally, locked radial column plating as an independent method of fixation has not been examined. We compare external fixation, locked volar plating, and locked radial column plating using functional and radiographic outcomes.
Methods: 46 patients were randomized as follows: 22 to external fixation, 12 to locked volar plating, and 12 to locked radial column plating. Fractures included OTA types A3 and C1-C3. Patients were followed postoperatively at 2, 6, 12, 24, and 52 weeks. Each visit patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; both wrists were evaluated for range of motion, grip, and lateral pinch strength; and radiographic parameters were recorded.
Results: At 6 weeks, volar plating showed a significantly better mean DASH score compared to external fixation (P = 0.037). At 3 months, volar plating maintained the best DASH score compared to both external fixation (P = 0.028) and radial column plating (P = 0.027). However, by 6 months there were no significant differences in DASH scores, and all three groups reached normative DASH scores at final follow-up. External fixation showed significantly better grip strength compared to radial column plating at 6 months (P = 0.042), while volar plating showed significantly better lateral pinch strength compared to radial column plating at 3 months (P = 0.042) and 1 year (P = 0.036). Range of motion did not significantly differ between groups at any time. Final radiographic measurements revealed radial column plating maintained better radial length and radial inclination than both volar plating and external fixation (all P < 0.05).
Conclusions: Locked volar plating leads to better patient-assessed outcomes than external fixation and locked radial column plating in the first 3 months following surgical fixation despite minimal differences in strength, motion, and radiographic alignment. All three surgical techniques provide excellent functional and radiographic outcomes by 1 year.
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. Δ OTA Grant.