Non-operative Treatment Versus Volar Locking Plate Fixation for Dorsally Displaced Distal Radius Fractures in the Elderly - a Randomized Controlled Trial
Jenny Saving, MD1; Sara Severin Wahlgren, MD2; Kristin Olsson, MD3; Anders Enocson, Associate Professor1; Sari Ponzer, Professor1; Olof Sköldenberg, Associate Professor2; Maria Wilcke, PhD1; Cecilia Mellstrand Navarro, PhD1
1Karolinska Institute, Stockholm, Sweden, 2Karolinska Institute, Danderyd, Sweden, 3Karolinska Institute, Mora, Sweden
Background: The usage of volar locking plate (VLP) fixation for distal radius fractures has increased in older patient populations, despite the fact that surgical treatment among elderly has not yet been proven superior to non-operative treatment. The purpose of the present study was to compare non-operative treatment to VLP fixation regarding clinical outcome for elderly patients with dorsally displaced distal radius fractures.
Methods: One-hundred and forty patients were randomly allocated to non-operative treatment with plaster cast (n=72) or VLP fixation (n=68). Outcome variables were Patient-Rated Wrist Evaluation (PRWE) score, Disabilities of the Arm Shoulder and Hand (DASH) score, EuroQol-5 Dimensions (EQ-5D) score, range of motion, grip strength, radiographs and complications. Evaluation was performed at 3 months and 12 months.
Results: One-hundred and twenty-two patients were evaluated at 3 months and one-hundred and nineteen at 12 months. At 3 months the VLP group had better PRWE score (mean difference (MD) 13.6 points, CI 5.0-22.2), grip strength (MD 21.5%, CI 11.5-31.5) and wrist flexion (MD 11 degrees, CI 5.3-18.0) than the non-operative group. The differences remained at 12 months for PRWE (MD 9.7 points, CI 3.1-16.4) and grip strength (MD 17.3%, CI 8.5-26.2) but did not reach the minimal clinically important differences. All other functional assessments were equal between the groups. Radiographic measurements favored VLP fixation at 3 and 12 months. Complication rates were similar with 11% major complications in the non-operative group compared to 14% in the VLP group (P=0.606) and 11% minor complications in the non-operative group compared to 20% in the VLP group (P=0.197).
Conclusions: PRWE and grip strength was better for the VLP group compared to the non-operative group at 3 months, but they were no longer at levels of clinical importance at 12 months. Complication rates were similar. Our results imply that it could be of benefit for the active elderly patient to be treated with a volar locking plate due to a dorsally displaced distal radius fracture.
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