Sat., 10/15/11 Recon, UE, Wrist & Hand, Paper #91, 4:39 pm OTA-2011
A Randomized Prospective Clinical Trial Comparing Treatment of Distal Radius Fractures with Volar Locking Plate and Conventional Percutaneous Methods
Alexia Karantana, MRCS1; Nicholas D. Downing, DM, FRCS(Orth)1;
Daren P. Forward, MA, FRCS, DM1; Mark Hatton, FRCS(Orth)1;
Professor Chris G. Moran, DM, FRCS(Ed)1; Andrew M. Taylor, DM, FRCS1;
Professor Brigitte E. Scammell, DM, FRCS(Orth)2; Professor Tim R. Davis, FRCS, MCh1;
1Queens Medical Centre, Nottingham University Hospitals NHS Trust,
Nottingham, United Kingdom;
2Division of Orthopaedic and Accident Surgery, University of Nottingham,
Nottingham, United Kingdom
Purpose: The aim of the study was to compare outcomes of distal radial fractures after treatment with either a volar locking plate, or percutaneous Kirschner-wiring ± spanning external fixator. The hypothesis was that the use of volar locking plates improves clinical and functional outcome.
Methods: This was a single-center pragmatic prospective randomized controlled surgical trial with intention-to-treat analysis. Recruited patients were randomized to treatment with either a volar locking plate, or percutaneous Kirschner-wiring ± spanning external fixator. The inclusion criteria were: (1) skeletally mature adult with no concomitant systemic disease, no previous associated fractures of either arm, and no preexisting radiographic abnormality; and (2) fracture of the distal radius that was dorsally displaced, extra-articular (with or without an undisplaced intra-articular component) with dorsal cortical comminution OR displaced intra-articular with an articular step or gap of >2 mm. The main outcome measure was the Patient Evaluation Measure (PEM) hand function questionnaire. Additional measures included the QuickDASH (shorter version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score, the EuroQol-5D (EQ-5D) standardized health status measure, grip strength, and range of motion. The level of significance was set at P <0.01.
Results: 130 participants aged 18 to 73 years were randomized (plate, n = 67; control, n = 63, of whom 54 were treated with Kirschner wires [K-wires] alone and 9 treated with external fixator ± K-wires). Follow-up at 1 year was 95%. Groups were balanced. The plate group had significantly better PEM and QuickDASH scores and range of motion at 6 weeks (P <0.001), but there were no differences in these measures at 3 months or 1 year. Grip strength was significantly better at 6 weeks (P <0.001) and 3 months (P <0.01), but not at 1 year for the plate group. Significantly more participants from the plate group were back to driving at the end of 6 weeks (P <0.001), but this did not translate to a difference in those returning to work by that time.
Conclusion: Use of a volar locking plate resulted in a faster recovery of function. There was no significant difference in the long-term outcome with the use of K-wires ± an external fixator.Alphabetical Disclosure Listing (628K PDF)
• 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.