Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year

Abstract

Background and purpose Promising results have been reported after volar locked plating of unstable dorsally displaced distal radius fractures. We investigated whether volar locked plating results in better patient-perceived, objective functional and radiographic outcomes compared to the less invasive external fixation.Patients and methods 63 patients under 70 years of age, with an unstable extra-articular or non-comminuted intra-articular dorsally displaced distal radius fracture, were randomized to volar locked plating (n = 33) or bridging external fixation. Patient-perceived outcome was assessed with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Patient-Rated Wrist Evaluation (PRWE) questionnaire.Results At 3 and 6 months, the volar plate group had better DASH and PRWE scores but at 12 months the scores were similar. Objective function, measured as grip strength and range of movement, was superior in the volar plate group but the differences diminished and were small at 12 months. Axial length and volar tilt were retained slightly better in the volar plate group.Interpretation Volar plate fixation is more advantageous than external fixation, in the early rehabilitation period.

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

“…Marcheix compared palmar fixed angle locking plate fixation to Kirshner wire fixation in a prospective randomized trial, reporting improved functional results (DASH and Herzog scores), with a plate, with better maintenance of reduction [21]. However, equivalent functional scores have also been reported when comparing locking plate fixation to external fixation [22,23], or to conservative treatment [24]. The latter of these studies, however, was in an elderly group of patients.…”

External Fixation and Adjuvant Pins Versus Volar Locking Plate Fixation in Unstable Distal Radius Fractures: A Randomized, Controlled Study With a 5-Year Follow-Up

“…The QuickDASH score, which we selected as the primary clinical outcome measure, was insignificantly different between the groups (VLP 9 vs EF 11; P ¼ . 4) Despite the lack of conclusive evidence, the use of VLP is a popular method for treating unstable distal radius fractures. In this randomized, controlled trial with a follow-up of greater than 5 years, we aimed to determine whether VLP were superior to EF and adjuvant pins for treating unstable distal radius fractures in terms of the clinical and radiological outcomes.…”

Analysis of the Arthroscopically Diagnosed Soft-Tissue Injuries Associated With the Distal Radius Fractures

“…Today, the modern trends for stable internal fixation with early aggressive mobilization gave way for the soft-tissue lesion to be more apparent, resulting in clinical instability and pain. This may be the reason why the studies that compared external fixation and percutaneous techniques, with the internal fixation with locked implants, failed to demonstrate significantly better outcome for the newer techniques [21][22][23][24]. In order to improve our understanding of the problem of residual pain and disability in distal radius fractures, attention to the soft-tissue injuries has to be paid.…”