title: Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial.
abstract: BACKGROUND
  Fractures of the distal radius are common and account for an estimated 17% of all fractures diagnosed. Two-thirds of these fractures are displaced and require reduction. Although distal radius fractures, especially extra-articular fractures, are considered to be relatively harmless, inadequate treatment may result in impaired function of the wrist. Initial treatment according to Dutch guidelines consists of closed reduction and plaster immobilisation. If fracture redisplacement occurs, surgical treatment is recommended. Recently, the use of volar locking plates has become more popular. The aim of this study is to compare the functional outcome following surgical reduction and fixation with a volar locking plate with the functional outcome following closed reduction and plaster immobilisation in patients with displaced extra-articular distal radius fractures.
  
  
  METHODS
  This single blinded randomised controlled trial will randomise between open reduction and internal fixation with a volar locking plate (intervention group) and closed reduction followed by plaster immobilisation (control group). The study population will consist of all consecutive adult patients who are diagnosed with a displaced extra-articular distal radius fracture, which has been adequately reduced at the Emergency Department. The primary outcome (functional outcome) will be assessed by means of the Disability Arm Shoulder Hand Score (DASH). Secondary outcomes comprise the Patient-Rated Wrist Evaluation score (PRWE), quality of life, pain, range of motion, radiological parameters, complications and cross-overs. Since the treatment allocated involves a surgical procedure, randomisation status will not be blinded. However, the researcher assessing the outcome at one year will be unaware of the treatment allocation. In total, 90 patients will be included and this trial will require an estimated time of two years to complete and will be conducted in the Academic Medical Centre Amsterdam and its partners of the regional trauma care network.
  
  
  CONCLUSIONS
  Ideally, patients would be randomised before any kind of treatment has been commenced. However, we deem it not patient-friendly to approach possible participants before adequate reduction has been obtained.
  
  
  BACKGROUND
  This study is registered at the Netherlands Trial Register (NTR3113) and was granted permission by the Medical Ethical Review Committee of the Academic Medical Centre on 01-10-2012.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, P,O, Box 22660, Amsterdam, DD 1100, The Netherlands. m.m.walenkamp@amc.nl.
authors.forename: Monique M J
authors.initials: MM
authors.lastname: Walenkamp
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.forename: Annechien
authors.initials: A
authors.lastname: Beumer
authors.forename: Robert
authors.initials: R
authors.lastname: Haverlag
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leenhouts
authors.forename: Egbert J M M
authors.initials: EJ
authors.lastname: Verleisdonk
authors.forename: Ronald S L
authors.initials: RS
authors.lastname: Liem
authors.forename: Jan Bernard
authors.initials: JB
authors.lastname: Sintenie
authors.forename: Maarten W G A
authors.initials: MW
authors.lastname: Bronkhorst
authors.forename: Jasper
authors.initials: J
authors.lastname: Winkelhagen
authors.forename: Niels W L
authors.initials: NW
authors.lastname: Schep
mesh_terms: D001696:Biomechanical Phenomena; D001860:Bone Plates; D002370:Casts, Surgical; D002985:Clinical Protocols; D004185:Disability Evaluation; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D018737:Hand Strength; D006801:Humans; D007103:Immobilization / Q000009:adverse effects / Q000379:methods*; D009426:Netherlands; D010147:Pain Measurement; D011788:Quality of Life; D011885:Radius Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012107:Research Design; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome