Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation

Abstract

Background:We sought to compare direct costs and clinical and radiographic outcomes for distal radius fractures (DRF) treated with open reduction internal fixation with volar locking plates (VLP) versus closed reduction and percutaneous pinning (CRPP). Methods:We identified patients with AO-type A and C1 DRFs from a prospective database. Outcomes were assessed at 6 weeks and at 3, 6 and 12 months, and surgical care costs were estimated.Results: Twenty patients were treated with CRPP and 24 with VLP. There were no significant differences in patient-rated wrist evaluation (PRWE) scores between the 2 groups at any time point (mean 16.2 ± 23.1 in the CRPP group v. 21.5 ± 23.6 in the VLP group, p = 0.91). Overall alignment was maintained in both groups; however, there was a greater loss of radial height over time with CRPP than VLP (0.97 mm v. 0.25 mm, p = 0.018). The mean duration of surgery was longer for VLP than CRPP (113.9 ± 39.5 min v. 86.5 ± 7.8 min, p = 0.029), but there were fewer clinic visits (5.2 ± 1.4 v. 7.8 ± 1.3, p < 0.001) and fewer radiographs (7.4 ± 2.7 v. 9 ± 2.4, p = 0.031). The total cost per case was greater for VLP than CRPP ($1637.27 v. $733.91). Conclusion:Based on PRWE scores, VLPs did not offer any significant advantage over CRPP in patients with simple fracture types between 3 and 12 months, but they were much more costly. Whether VLP offers any functional advantage earlier in recovery, thereby justifying their expense, requires further investigation in the form of a prospective randomized trial with a detailed cost analysis.Contexte : Nous avons voulu comparer les coûts directs et l'issue clinique et radiographique du traitement des fractures du radius distal (FRD) au moyen d'une technique de réduction ouverte avec fixation interne par plaques palmaires de stabilisation (PPS) par rapport à la méthode par réduction fermée et enclouage percutané (RFEP).Méthodes : Nous avons recensé les patients victimes d'une FRD de type AO et de type C1 à partir d'une base de données prospectives. L'issue de ces fractures a été évaluée après 6 semaines, puis après 3, 6 et 12 mois et nous avons estimé les coûts des soins chirurgicaux.Résultats : Vingt patients ont été traités par RFEP et 24 par PPS. On n'a noté aucune différence significative entre les 2 groupes quant aux scores d'évaluation des poignets par les patients eux-mêmes, peu importe le moment de l'évaluation (moyenne 16,2 ± 23,1 dans le groupe traité par RFEP c. 21,5 ± 23,6 dans le groupe traités par PPS, p = 0,91). L'alignement global a été maintenu dans les 2 groupes; toutefois, on a observé une diminution plus marquée de la longueur du radius avec le temps dans les cas de RFEP que dans les cas de PPS (0,97 mm c. 0,25 mm, p = 0,018). La durée moyenne de la chirurgie a été plus longue avec la PPS qu'avec la RFEP (113,9 ± 39,5 min c. 86,5 ± 7,8 min, p = 0,029), mais les visites à la clinique et les radiographies ont été moins nombreuses (respectivement, 5,2 ± 1,4 c. 7,8 ± 1,3, p < 0,001 et 7,4 ± 2,7 c. 9 ± 2,4, p = 0,031). Le coût total par cas a...

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

“…It has been argued that in the absence of convincing evidence of superiority of volar locking plates, economic considerations should drive clinical decision-making and policy in the treatment of dorsally displaced distal radius fractures [8,9,40]. However, a robust economic analysis will need to consider differences in costs associated with complications (eg, antibiotic treatment for superficial infections) in addition to differences in costs of the implants, length of surgery, requirement for adjunctive treatments (eg, external fixation, casting), and postoperative protocols (eg, clinic visits, radiographs) [8].…”

Distal radial fractures

“…Restoration of volar tilt was significantly better in the VLP group at all time-points, but there was no clinically relevant difference between groups beyond 6 mo, revealing that advantages of VLPs may subside over time. Similarly, Dzaja et al 17 reviewed 44 patients from a prospective database and found no difference between VLP and closed reduction, percutaneous pinning (CRPP) in patient-rated wrist evaluation scores at any time point, although VLPs maintained radial height better over time. A randomized controlled trial conducted by Karantana et al 14 compared the outcomes of 130 displaced distal radial fractures treated with either VLP or percutaneous Kirschner-wire and bridging external fixation.…”

“…13 During the review period (2013--2014), several level 1 investigations involving volar locking plates were published. 17 In contrast to these findings, a level 1 randomized study performed by Williksen et al 18 randomized 111 unstable distal radial fractures to treatment with a VLP or external fixation with adjuvant pins. At 6 wk, the VLP group had superior outcomes in nearly all radiographic and clinical categories.…”

“…13,14,15,17,18 Longer-term follow-up in prospective randomized studies is necessary to reveal whether anatomic reduction ultimately will improve outcomes. However, the data regarding outcome have revealed that VLPs have equivalent clinical results at 1 yr when compared with more traditional fixation techniques.…”

Comparison of effects of seven treatment methods for distal radius fracture on minimizing complex regional pain syndrome

“…A number of studies have shown that bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating and dorsal and volar plating have high efficacy for DRF treatment [12, 17, 19]. However, there have been several attempts to rank the seven treatment strategies, and disagreements exist on their efficacy in treatment of DRF [11, 15, 20]. …”