title: Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial.
abstract: Fractures of the distal radius are commonly treated with cast immobilisation; however, those potentially unstable injuries with dorsal comminution may need operative intervention. This intervention is usually with manipulation and Kirschner wires but advances in locking-plate technology have enabled surgeons to achieve anatomical reconstruction of complex fracture patterns, even in poor-quality osteoporotic bone.To ascertain if fixed-angle volar-locked plates confer a significant benefit over manipulation and Kirschner-wire stabilisation, we prospectively randomised 56 adult patients with isolated, closed,unilateral, unstable extra-articular fractures into two treatment groups, one fixed with K-wires and the other fixed with a volar locking plate.Functional outcomes were assessed using Gartland and Werley and Disabilities of the Arm, Shoulder and Hand (DASH) scores. These were statistically better in the plate group at 3 and 6 months.Radiological assessment showed statistically better results at 6 weeks, 3 months and 6 months, postoperatively.In the plate group, there was no significant loss of fracture reduction.
authors.affiliation: Department of Trauma and Orthopaedics, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
authors.forename: I
authors.initials: I
authors.lastname: McFadyen
authors.forename: J
authors.initials: J
authors.lastname: Field
authors.forename: P
authors.initials: P
authors.lastname: McCann
authors.forename: J
authors.initials: J
authors.lastname: Ward
authors.forename: S
authors.initials: S
authors.lastname: Nicol
authors.forename: C
authors.initials: C
authors.lastname: Curwen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D053401:Palmar Plate; D011446:Prospective Studies; D011885:Radius Fractures / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult