External Fixation and Adjuvant Pins Versus Volar Locking Plate Fixation in Unstable Distal Radius Fractures: A Randomized, Controlled Study With a 5-Year Follow-Up.
OBJECTIVE
To determine whether volar locking plates (VLP) are superior to external fixation (EF) with adjuvant pins in unstable distal radius fractures after 5 years of follow-up.


METHODS
We randomized 111 unstable distal radius fractures to treatment with either a VLP or EF using adjuvant pins. The patients' mean age was 54 years (range, 20-84 y). Twenty patients were lost to follow-up. At 5 years, 91 patients (82%) were assessed using the visual analog scale (VAS) pain score, Mayo wrist score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, range of motion, and radiological evaluation. The QuickDASH score at 5 years was the primary outcome measure.


RESULTS
The QuickDASH score was not statistically significantly different between the groups (VLP 10 vs EF 13) at 5 years. Patients with VLP had statistically significant better supination (85° vs 81°), better radial deviation (18° vs 16°), and less radial shortening (1 mm vs 2 mm). For AO/OTA type C2 fractures, the VLP had statistically significant better supination (84° vs 78°), flexion (64° vs 56°), grip strength (34 kg vs 28 kg), Mayo wrist score (92 vs 76), and less ulnar shortening (1 mm vs 3 mm). The QuickDASH score in the C2 subset analysis showed a difference of 10 (VLP 8 vs EF 18), but this was not statistically significant. In the VLP group, 11 patients (21%) had their plates removed owing to surgically related complications. In the EF group, 5 patients had proximal radial scar correction surgery owing to skin contracture.


CONCLUSIONS
The findings were satisfactory for both groups at 5 years. The VLP provided statistically significantly better results for several clinical outcomes in the C2 subset analysis. However, 21% of the VLPs were removed because of surgical complications.


METHODS
Therapeutic I.
Orthopaedic Department, Oslo University Hospital, Oslo, Norway. Electronic address: john.williksen@me.com.
John H
JH
Williksen
Orthopaedic Department, Oslo University Hospital, Oslo, Norway.
Torstein
T
Husby
Department of Radiology, Oslo University Hospital, Oslo, Norway.
Johan C
JC
Hellund
Department of Orthopaedic and Plastic Surgery, University of Northern Norway, Tromsoe, Norway.
Hebe D
HD
Kvernmo
Orthopaedic Department, Oslo University Hospital, Oslo, Norway.
Carina
C
Rosales
Orthopaedic Department, Oslo University Hospital, Oslo, Norway.
Frede
F
Frihagen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome
Distal radius fractures; external fixation; open reduction internal fixation; randomized clinical trial; volar locking plates