1. Volar Plate Fixation Versus Cast Immobilization in Acceptably Reduced Intra-Articular Distal Radial Fractures: A Randomized Controlled Trial.
- Author
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Selles CA, Mulders MAM, Winkelhagen J, van Eerten PV, Goslings JC, and Schep NWL
- Subjects
- Adolescent, Adult, Aged, Bone Plates, Female, Follow-Up Studies, Fracture Fixation, Internal methods, Hand Strength physiology, Humans, Intra-Articular Fractures diagnosis, Intra-Articular Fractures physiopathology, Male, Middle Aged, Radius Fractures diagnosis, Radius Fractures physiopathology, Range of Motion, Articular, Treatment Outcome, Wrist Injuries diagnosis, Wrist Injuries physiopathology, Wrist Joint diagnostic imaging, Young Adult, Casts, Surgical, Fracture Fixation, Internal instrumentation, Intra-Articular Fractures therapy, Radius Fractures therapy, Wrist Injuries therapy
- Abstract
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.)
- Published
- 2021
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