Author(s): Williksen JH, Frihagen F, Hellund JC, Kvernmo HD, Husby T
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Abstract PURPOSE: To determine whether volar locking plates are superior to external fixation with adjuvant pins in the treatment of unstable distal radius fractures. METHODS: A total of 111 unstable distal radius fractures were randomized to treatment with external fixation (EF) using adjuvant pins or with a volar locking plate (VLP). The mean age of the patients was 54 years (range, 20-84 y). Seven patients were lost to follow-up. At 1 year, 104 patients were assessed with a visual analog scale pain score, Mayo wrist score, Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH), range of motion, and radiological evaluation. The QuickDASH score at 52 weeks was the primary outcome measure. RESULTS: The operative time in the EF group was 77 minutes, compared with 88 minutes in the VLP group. At 52 weeks, patients with VLPs had a higher Mayo wrist score (90 vs. 85), better supination (89° vs. 85°), and less radial shortening (+1.4 mm vs. +2.2 mm). There were more patients with pain over the ulnar styloid in the EF group (16 vs 6 patients). For AO type C2/C3, the patients with VLPs had better supination (90° vs. 76°) and less ulnar shortening (+1.1 mm vs. +2.8 mm). The complication rate was 30\% in the EF group, compared with 29\% in the VLP group. Eight (15\%) plates were removed due to complications. The QuickDASH score was not significantly different between the groups. CONCLUSIONS: Although we did not find a significant difference between the groups for the QuickDASH score, we believe that our results support the use of VLPs for the treatment of unstable distal radius fractures. A serious concern is that some patients will have to have their plates removed; therefore, improving the surgical technique is important. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
This article was published in J Hand Surg Am
and referenced in Journal of Trauma & Treatment