Surgical Treatment of Distal Radial Fractures with External Fixation Versus Volar Locking Plate: A Multicenter Randomized Controlled Trial
| Autor: | Kjell Matre, Rakel Sif Gudmundsdottir, Yngvar Krukhaug, Eva Dybvik, Jonas M. Fevang, Trine Ludvigsen |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Wrist Joint medicine.medical_specialty Adolescent External Fixators Visual analogue scale Radiography medicine.medical_treatment Wrist law.invention Radial fractures 03 medical and health sciences External fixation Grip strength Fracture Fixation Internal Young Adult 0302 clinical medicine Randomized controlled trial law Fracture Fixation medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Range of Motion Articular Aged 030222 orthopedics Hand Strength business.industry General Medicine Middle Aged Surgery medicine.anatomical_structure Treatment Outcome Female business Range of motion Radius Fractures Bone Plates |
| Zdroj: | Journal of Bone and Joint Surgery. American volume |
| ISSN: | 1535-1386 |
| Popis: | BACKGROUND The use of volar locking plate fixation (VLP) for unstable extra-articular distal radial fractures has increased in the last decades. External fixation (EF) is less frequently used. This change of surgical approach has only to some extent been evidence-based. METHODS In this multicenter, randomized controlled trial, we compared VLP and EF in patients between 18 and 70 years of age who had a displaced extra-articular distal radial fracture (OTA/AO type A3). The patients were examined at 6 weeks, 3 months, and 1 year postoperatively. The primary outcome measure was the Patient-Rated Wrist/Hand Evaluation score (PRWHE). Secondary outcomes were the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain score on a visual analog scale (VAS), and radiographic measurements. Range of motion, grip strength, finger stiffness, complications, and reoperations were also recorded. RESULTS One hundred and fifty-six patients were included. One hundred and forty-two (91%)-127 women (89%) and 15 men (11%)-completed 1 year of follow-up. Sixty-nine patients were treated with VLP and 73, with EF. The mean age was 56 years. At 6 weeks, the median PRWHE score was significantly higher in the EF group (44) compared with the VLP group (27) (p < 0.001). At 3 months and 1 year, the difference between groups was not significant. The median QuickDASH score was 27 in the VLP group and 43 in the EF group at 6 weeks (p < 0.001), and a significant difference persisted at 3 months (p = 0.023). The VLP group had superior results in terms pain during activity, wrist extension, and ulnar and radial deviation at 1 year, whereas the number of major complications was similar in the 2 groups. CONCLUSIONS Patients treated with VLP had earlier recovery of function compared with patients treated with EF. One year postoperatively, we found no significant functional difference. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|