Elsevier

Injury

Volume 42, Issue 2, February 2011, Pages 162-166
Injury

Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial

https://doi.org/10.1016/j.injury.2010.07.236Get rights and content

Abstract

Fractures of the distal radius are commonly treated with cast immobilisation; however, those potentially unstable injuries with dorsal comminution may need operative intervention. This intervention is usually with manipulation and Kirschner wires but advances in locking-plate technology have enabled surgeons to achieve anatomical reconstruction of complex fracture patterns, even in poor-quality osteoporotic bone.

To ascertain if fixed-angle volar-locked plates confer a significant benefit over manipulation and Kirschner-wire stabilisation, we prospectively randomised 56 adult patients with isolated, closed, unilateral, unstable extra-articular fractures into two treatment groups, one fixed with K-wires and the other fixed with a volar locking plate.

Functional outcomes were assessed using Gartland and Werley and Disabilities of the Arm, Shoulder and Hand (DASH) scores. These were statistically better in the plate group at 3 and 6 months. Radiological assessment showed statistically better results at 6 weeks, 3 months and 6 months, post-operatively. In the plate group, there was no significant loss of fracture reduction.

Section snippets

Materials and methods

This study was performed at two district general hospitals, serving a combined patient population of 500 000. Approval was granted by the regional medical ethics committee.

Patients with closed, unilateral, dorsally displaced, unstable extra-articular distal radius fractures (AO classification type A) were eligible for inclusion and were admitted either from the emergency department or from the fracture clinic. Instability was defined as dorsal angulation (>20°), dorsal comminution and radial

Statistical analysis

A power analysis was performed by a medical statistician, who calculated the sample size that would detect either any significant change in radial length or dorsal inclination, or a difference in DASH or Gartland and Werley scores.

Data were summarised by medians rather than means because of the non-normal distribution. For the same reason, groups were compared using non-parametric Mann–Whitney U-tests. Fisher's exact test was used to compare the number of complications in the plate group and

Results

Patients were prospectively recruited over a 36-month period. A total of 79 patients met the criteria for inclusion. Of these, 56 agreed to participate. Thus, 27 patients were entered into the study directly on admission to hospital. A total of 29 patients were entered into the study via the fracture clinic at 1 week when it was identified that the fracture position had slipped with cast treatment. Nineteen of these latter patients had undergone closed manipulation and plaster-cast treatment by

Discussion

This is the first prospective randomised controlled trial to examine the outcomes of percutaneous pinning versus locked-plate fixation for unstable extra-articular fractures of the distal radius. We have found both superior functional and radiological outcomes at 3 and 6 months post-injury in injuries treated within locked internal fixation. Patients in this group also had significantly less complications than those treated with percutaneous pinning.

The ability of fixed-angle volar plates to

Conflict of interest

There are no conflicts of interest, financial or otherwise.

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