Comparing the effect of volar plate fixators and external fixators on outcome of patients with intra-articular distal radius fractures
A clinical trial
Keywords:
Distal radius fracture, External fixator method, Internal fixationAbstract
Background: Distal radius fractures (DRFs) are much more prone to malunion than unstable extra-articular fractures. There is no clear consensus concerning what the proper treatment should be, and the best approach to use for displaced DRFs remains challenging.
Objective: To compare the effect of two different therapeutic surgical methods, i.e., volar plate fixators and external fixators, on outcomes of patients with intra-articular distal radius fractures.
Methods: From May 2010 to November 2014, 76 subjects who had experienced intra-articular fractures of the distal radius were enrolled in this double-blind, randomized, controlled trial in Imam Ali Hospital in Bojnourd, Iran. The patients were divided into two groups, i.e., 1) patients who were treated with internal fixation using the volar plate (group A) and 2) patients who were treated with external fixators (group B). The primary outcome was a composite measure of the patient’s quality of life using three different scores, i.e., 1) the MAYO score, 2) Disabilities of the Arm, Shoulder, and Hand (DASH (score, and 3) the Short Form (36) (SF-36) Health Survey score.
Results: A total of 76 patients were allocated randomly to groups A and B. The mean ages for external fixator cases and volar plate cases were 51.7 and 46.3, respectively. No significant age distribution was seen between the two groups (p=0.348). Gender distribution between the two groups was not significantly different (p=0.022). Grip power was significantly different between the two groups, but no significant differences were detected in range of motion (p=0.008, p=0.367, respectively). The MAYO score was significantly higher in the open reduction and internal fixation (ORIF) group, and, according to the SF-36 test, the ORIF group also a higher level of general mental and physical health, social functioning, and personal physical functioning than the other group. However, postoperatively, the mental discomfort and physical discomfort were more prevalent in the external fixator group. The DASH score was not significantly different between the two groups (p=0.124).
Conclusions: ORIF and its subtitle, volar plate fixation, is a more preferred surgical procedure than the external fixator for the treatment of intra-articular distal radius fractures. This conclusion is important when one considers cost-effectiveness and an earlier return to work.
Trial registration: The trial is registered at the Thai Clinical Trial Registry (clinicaltrials.in.th) with the TCR identification number TCTR20150609002
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
References
Cooney W, Linscheid R, Dobyns J. External pin fixation for unstable Colles’ fractures. J Bone Joint Surg Am.
; 61(6A): 840-5. PMID: 479230
Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing
nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in
patients sixty-five years of age and older. J Bone Joint Surg Am. 2011; 93(23):2146-53. doi:
2106/JBJS.J.01597. PMID: 22159849
Arora R1, Gabl M, Erhart S, Schmidle G, Dallapozza C, Lutz M. Aspects of current management of distal
radius fractures in the elderly individuals. Geriatr Orthop Surg Rehabil. 2011; 2(5-6):187-94. doi:
1177/2151458511426874. PMID: 23569689
Plate JF, Gaffney DL, Emory CL, Mannava S, Smith BP, Koman LA, et al. Randomized comparison of volar
locking plates and intramedullary nails for unstable distal radius fractures. J Hand Surg Am. 2015; 40 (6):1095- 101. doi: 10.1016/j.jhsa.2015.02.014. PMID: 25840480
Xia S, Lu Y, Wang H, Wu Z, Wang Z. Open reduction and internal fixation with conventional plate via L- shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal
fractures - a randomized controlled trial. Int J Surg. 2014; 12(5): 475-80. doi: 10.1016/j.ijsu.2014.03.001.
PMID: 24607889
Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal radius fractures
treated with a volar locking plate system. J Hand Surg Am. 2008; 33 (5):691-700. doi:
1016/j.jhsa.2008.01.024. PMID: 18590852
Noble P, Marshall A, Barron O, Catalano L. Malpractice in distal radius fracture management: an analysis of
closed claims. J Hand Surg Am. 2014; 39(8):1480-8. doi: 10.1016/j.jhsa.2014.02.019. PMID: 24785702
Chung K, Shauver M, Birkmeyer J. Trends in the United States in the treatment of distal radial fractures in the
elderly. J Bone Joint Surg Am. 2009; 91(8):1868-73. doi: 10.2106/JBJS.H.01297. PMID: 19651943
Leung F, Tu Y, Chew W, Chow S. Comparison of external and percutaneous pin fixation with plate fixation for
intra-articular distal radial fractures. A randomized study. J Bone Joint Surg Am. 2008; 90(1):16-22. doi:
2106/JBJS.F.01581. PMID: 18171953
Valdes K, Naughton N, Burke C. Therapist-supervised hand therapy versus home therapy with therapist
instruction following distal radius fracture. J Hand Surg Am. 2015; 40(6):1110-16. doi:
1016/j.jhsa.2015.01.036. PMID: 25817323
Brehmer J, Husband J. Accelerated rehabilitation compared with a standard protocol after distal radial fractures
treated with volar open reduction and internal fixation: a prospective, randomized, controlled study. J Bone
Joint Surg Am. 2014; 96(19):1621-30. doi: 10.2106/JBJS.M.00860. PMID: 25274787
Gradl G, Mielsch N, Wendt M, Falk S, Mittlmeier T, Gierer P,et al. Intramedullary nail versus volar plate
fixation of extra-articular distal radius fractures. Two year results of a prospective randomized trial. Injury.
; 45 Suppl 1:S3-8. doi: 10.1016/j.injury.2013.10.045. PMID: 24268189
Goehre F, Otto W, Schwan S, Mendel T, Vergroesen P, Lindemann L. Comparison of palmar fixed-angle plate
fixation with K-wire fixation of distal radius fractures (AO A2, A3, C1) in elderly patients. J Hand Surg Eur
Vol. 2014; 39(3):249-57. doi: 10.1177/1753193413489057. PMID: 23677960
Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing
nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in
patients sixty-five years of age and older. J Bone Joint Surg Am. 2011; 93(23):2146-53. doi:
2106/JBJS.J.01597. PMID: 22159849
Fadyen I, Field J, McCann P, Ward J, Nicol S, Curwen C. Should unstable extra-articular distal radial fractures
be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised
controlled trial. Injury. 2011; 42(2):162-6. doi: 10.1016/j.injury.2010.07.236. PMID: 20691441
Zettl R, Clauberg E, Nast-Kolb D, Ruchholtz S, Kühne C. Volar locking compression plating versus dorsal
plating for fractures of the distal radius: a prospective, randomized study. Unfallchirurg. 2009; 112(8):712-8.
doi: 10.1007/s00113-008-1526-5. PMID: 19597773
Wei D, Raizman N, Bottino C, Jobin C, Strauch R, Rosenwasser M. Unstable distal radial fractures treated with
external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am.
; 91 (7):1568-77. doi: 10.2106/JBJS.H.00722. PMID: 19571078.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
