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Volar Locking Plates Versus External Fixation and Adjuvant Pin Fixation in Unstable Distal Radius Fractures: A Randomized, Controlled Study - Clinical Outcomes at 5 Years
John H. Williksen, MD1; Frede Frihagen, MD, PhD1; Johan C. Hellund, MD, PhD1; Hebe D. Kvernmo, MD, PhD2, Carina Rosales, OT1; Torstein Husby, MD, PhD1
1Department of Orthopaedics, Oslo University Hospital, Oslo, Norway; 2Department of Orthopaedics, University Hospital of North Norway, Tromso, Norway

Introduction: To determine whether volar locking plates are superior to external fixation with adjuvant pins in the treatment of unstable distal radius fractures.

Materials & 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). At 5 years (66 months) 22 patients were lost to follow-up and 89 were clinically assessed (80%), 76 women and 13 men. In the EF group there were 44 patients with 1 A2, 10 A3, 22 C1, 9 C2 and 2 C3 fractures. In the VLP there were 45 patients with 2 A2, 10 A3, 16 C1, 16 C2 and 1 C3 fractures (AO/ ASIF). The patients were assessed with a visual analog scale (VAS) pain score at rest and at activity (act), Mayo Wrist Score (MWS), Quick-Disabilities of the Arm, Shoulder, and Hand (QDASH) and range of motion. The QDASH score at 66 months was the primary outcome measure.

Results: The majority of the clinical outcomes varied insignificantly between the treatment groups and were good in both groups. MWS: EF 87 vs. VLP 90, P= .3. VAS rest: EF 4 vs. VLP 1, P= .2. VAS act.: EF 10 vs. VLP 6, P= .2. Flexion: EF 61 vs. VLP 64, P= . 1. Extension: EF 63 vs. VLP 65 P= .3. Pronation: EF 83 vs. VLP 83, P= .9.

The QDASH score was not significantly different between the groups at 66 months (EF 13 vs. VLP 10, P= .3).
The only statistically significant result favouring the VLPs was forearm supination (EF 81 vs. VLP 85, P= .009).
In the VLP group 14 plates were removed, 12 (23%) of them due to plate-related complications. In the EF group 4 patients were operated with scar correction at the proximal radial scar and 2 patients still have some finger stiffness, in 1 due to CRPS.

Conclusions: There was no statistically significant difference between the groups for the QDASH score, and in general the clinical results were similar and overall good in both groups. A concern is that almost a quarter of the VLP patients needed plate removal due to surgical complications.


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