Volar Plate Fixation Versus Cast Immobilization in Acceptably Reduced Intra-Articular Distal Radial Fractures: A Randomized Controlled Trial.

Autor:	Selles CA; Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.; Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands., Mulders MAM; Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands., Winkelhagen J; Department of Surgery, Dijklander Ziekenhuis, Hoorn, the Netherlands., van Eerten PV; Department of Surgery, Maxima Medical Center, Veldhoven, the Netherlands., Goslings JC; Department of Surgery, OLVG, Amsterdam, the Netherlands., Schep NWL; Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2021 Nov 03; Vol. 103 (21), pp. 1963-1969.
DOI:	10.2106/JBJS.20.01344
Abstrakt:	Background: The evidence for the treatment of acceptably reduced intra-articular distal radial fractures remains inconclusive. We therefore compared the functional outcomes of cast immobilization (nonoperative) and volar plate fixation (operative) for patients with these fractures. Methods: This multicenter randomized controlled trial enrolled patients between 18 and 75 years old with an acceptably reduced intra-articular distal radial fracture. Patients were randomized to nonoperative treatment or to operative treatment. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score after 12 months. Secondary outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; the Short Form-36 (SF-36) questionnaire; a visual analog scale for pain; range of motion; grip strength; radiographic parameters; and complications. Analyses followed the intention-to-treat principle. Results: A total of 96 patients were randomized, and 90 (46 in the nonoperative group and 44 in the operative group) were included in the analysis. Patients treated in the operative group had significantly better functional outcomes measured with the PRWE at 6 weeks, 3 months, 6 months, and 1 year. Additionally, a 28% rate of subsequent surgery was identified in the nonoperative group. Conclusions: Adult patients with an acceptably reduced intra-articular distal radial fracture have better functional outcomes for 12 months when treated operatively instead of nonoperatively. We therefore recommend surgical treatment for patients with these fractures. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G645). (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
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