Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management.
BACKGROUND
To evaluate the functional and radiographic outcomes, as well as the treatment costs, of closed displaced intra-articular distal radius fractures treated with either open reduction internal fixation (ORIF) with volar locking plates or nonoperative treatment with plaster cast immobilisation.


METHODS
A total of 60 patients (32 receiving ORIF, 28 receiving nonoperative treatment) with closed intra-articular distal radius fractures were included. The mean age was 52.1 and 57.4, respectively. Functional and radiographic assessments were carried out at 12 months post-injury. Patients' treatment costs, median salaries and lengths of medical leave were obtained.


RESULTS
DASH and MAYO wrist score in the ORIF group did not differ significantly from those in the nonoperative group. Apart from superior ulnar deviation in the ORIF group (p = 0.0096), differences in the range of motion of the injured wrists were not significant. Similarly, there were no significant differences in grip strength and visual analog scale for pain. Volar tilt (p = 0.0399), radial height (p = 0.0087), radial inclination (p = 0.0051) and articular step-off (p = 0.0002) were all significantly superior in the ORIF group. There was a 37-fold difference in mean treatment costs between ORIF (SGD 7951.23) and nonoperative treatment (SGD 230.52).


CONCLUSIONS
Our study shows no difference in overall functional outcomes at 12 months for closed displaced intra-articular distal radius fractures treated with either ORIF with volar locking plates or plaster cast immobilisation, and this is independent of radiographic outcome. A longer follow-up, nevertheless, is needed to determine whether the development of post-traumatic arthritis will have an effect on function. The vast difference in treatment costs should be taken into consideration when deciding on the treatment option.


METHODS
Level 3.
Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore. toondonghao@hotmail.com.
Dong Hao
http://orcid.org/0000-0002-0618-730X
DH
Toon
Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
Rex Antony Xavier
RAX
Premchand
Rehabilitation Services, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
Jane
J
Sim
Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
Rajaratnam
R
Vaikunthan
D000328:Adult; D000368:Aged; D001860:Bone Plates; D002370:Casts, Surgical / Q000191:economics; D000072700:Conservative Treatment / Q000191:economics / Q000379:methods; D005260:Female; D005592:Fracture Fixation / Q000191:economics / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000191:economics / Q000379:methods; D006801:Humans; D057072:Intra-Articular Fractures / Q000191:economics / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000191:economics / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
Adult; Cast; Fracture fixation; Health care costs; Intra-articular fractures; Radius fractures; Range of motion; Surgical; Wrist joint