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Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures: a randomized, controlled study.
J Hand Surg Am. 2013 Aug;38(8):1469-76
Authors: Williksen JH, Frihagen F, Hellund JC, Kvernmo HD, Husby T
Abstract
PURPOSE: To determine whether volar locking plates are superior to external fixation with adjuvant pins in the treatment of unstable distal radius fractures.
METHODS: A total of 111 unstable distal radius fractures were randomized to treatment with external fixation (EF) using adjuvant pins or with a volar locking plate (VLP). The mean age of the patients was 54 years (range, 20-84 y). Seven patients were lost to follow-up. At 1 year, 104 patients were assessed with a visual analog scale pain score, Mayo wrist score, Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH), range of motion, and radiological evaluation. The QuickDASH score at 52 weeks was the primary outcome measure.
RESULTS: The operative time in the EF group was 77 minutes, compared with 88 minutes in the VLP group. At 52 weeks, patients with VLPs had a higher Mayo wrist score (90 vs 85), better supination (89° vs 85°), and less radial shortening (+1.4 mm vs +2.2 mm). There were more patients with pain over the ulnar styloid in the EF group (16 vs 6 patients). For AO type C2/C3, the patients with VLPs had better supination (90° vs 76°) and less ulnar shortening (+1.1 mm vs +2.8 mm). The complication rate was 30% in the EF group, compared with 29% in the VLP group. Eight (15%) plates were removed due to complications. The QuickDASH score was not significantly different between the groups.
CONCLUSIONS: Although we did not find a significant difference between the groups for the QuickDASH score, we believe that our results support the use of VLPs for the treatment of unstable distal radius fractures. A serious concern is that some patients will have to have their plates removed; therefore, improving the surgical technique is important.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
PMID: 23890493 [PubMed - in process]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23890493?dopt=Abstract
