Unstable Distal Radial Fractures Treated with External Fixation, a Radial Column Plate, or a Volar Plate: A Prospective Randomized Trial

Wei, David H.; Raizman, Noah M.; Bottino, Clement J.; Jobin, Charles M.; Strauch, Robert J.; Rosenwasser, Melvin P.
July 2009
Journal of Bone & Joint Surgery, American Volume;Jul2009, Vol. 91-A Issue 7, p1568
Academic Journal
Background: Optimal surgical management of unstable distal radial fractures is controversial, and evidence from rigorous comparative trials is rare. We compared the functional outcomes of treatment of unstable distal radial fractures with external fixation, a volar plate, or a radial column plate. Methods: Forty-six patients with an injury to a single limb were randomized to be treated with augmented external fixation (twenty-two patients), a locked volar plate (twelve), or a locked radial column plate (twelve). The fracture classifications included Orthopaedic Trauma Association (OTA) types A3, C1, C2, and C3. The patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at the time of follow-up. Grip and lateral pinch strength, the ranges of motion of the wrist and forearm, and radiographic parameters were also evaluated. Results: At six weeks, the mean DASH score for the patients with a volar plate was significantly better than that for the patients treated with external fixation (p = 0.037) but similar to that for the patients with a radial column plate (p = 0.33). At three months, the patients with a volar plate demonstrated a DASH score that was significantly better than that for both the patients treated with external fixation (p = 0.028) and those with a radial column plate (p = 0.027). By six months and one year, all three groups had DASH scores comparable with those for the normal population. At one year, grip strength was similar among the three groups. The lateral pinch strength of the patients with a volar plate was significantly better than that of the patients with a radial column plate at three months (p = 0.042) and one year (p = 0.036), but no other significant differences in lateral pinch strength were found among the three groups at the other follow-up periods. The range of motion of the wrist did not differ significantly among the groups at any time beginning twelve weeks after the surgery. At one year, the patients with a radial column plate had maintained radial inclination and radial length that were significantly better than these measurements in both the patients treated with external fixation and those with a volar plate (all p < 0.05). Conclusions: Use of a locked volar plate predictably leads to better patient-reported outcomes (DASH scores) in the first three months after fixation. However, at six months and one year, the outcomes of all three techniques evaluated in this study were found to be excellent, with minimal differences among them in terms of strength, motion, and radiographic alignment.


Related Articles

  • Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius. Broome, Brandon; Mauffrey, Cyril; Statton, Jeremy; Voor, Mike; Seligson, David // Journal of Orthopaedics & Traumatology;Jun2012, Vol. 13 Issue 2, p89 

    Background: Anatomic reduction of intra-articular fractures of the tibial plateau and distal radius can be difficult to achieve. Treatment goals are centered on restoring the native anatomy and articular congruency. Several surgeons in the USA have begun using an inflatable bone tamp to reduce...

  • Arthroscopic refixation of a combined fracture of the greater and lesser tuberosity of the proximal humerus. Pauly, S.; Herrmann, S.; Perka, C.; Greiner, S. // Knee Surgery, Sports Traumatology, Arthroscopy;May2013, Vol. 21 Issue 5, p1171 

    Combined fractures of the greater and the lesser tuberosity are very rare injuries. This is a case report on arthroscopic treatment using suture anchors and one distal fixation screw. Clinical and radiographic follow-up showed recovery of active motion and consolidation of the fragments in...

  • Volumetric analysis of corticocancellous bones using CT data. Krappinger, Dietmar; Linde, Astrid; Rosenberger, Ralf; Glodny, Bernhard; Blauth, Michael; Niederwanger, Christian // Skeletal Radiology;May2012, Vol. 41 Issue 5, p503 

    Objective: To present a method for an automated volumetric analysis of corticocancellous bones such as the superior pubic ramus using CT data and to assess the reliability of this method. Materials and methods: Computed tomography scans of a consecutive series of 250 patients were analyzed. A...

  • Shoulder hemiarthroplasty for fracture with a conservative rehabilitation regime. Amirfeyz, Rouin; Sarangi, Partha // Archives of Orthopaedic & Trauma Surgery;Sep2008, Vol. 128 Issue 9, p985 

    Standard rehabilitation regime following hemiarthroplasty for trauma is early mobilisation to prevent the development of a stiff shoulder. However, an aggressive early rehabilitation may lead to non-union of the greater tuberosity. We hypothesise that a delayed rehabilitation will result in a...

  • Dynamic Compared with Static External Fixation of Unstable Fractures of the Distal Part of the Radius: A Prospective, Randomized Multicenter Study. Hove, Leiv M.; Krukhaug, Yngvar; Revheim, Kåre; Helland, Per; Finsen, Vilh // Journal of Bone & Joint Surgery, American Volume;Jul2010, Vol. 92-A Issue 8, p1687 

    Background: External fixation is an established method of treating certain types of distal radial fractures. We have designed a dynamic external fixator to treat these fractures. The purpose `of the present study was to compare this device with current static bridging external fixators in terms...

  • Low intensity pulsed ultrasonography for fractures: systematic review of randomised controlled trials. Busse, Jason W.; Kaur, Jagdeep; Mollon, Brent; Bhandari, Mohit; Tornetta III, Paul; Schünemann, Holger J.; Guyatt, Gordon H. // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;3/14/2009, p644 

    The article presents a systematic review of randomised controlled trials that examined the efficacy of low intensity pulsed ultrasonography for fracture healing. A literature search of databases including CINAHL, Embase, and Medline was conducted to identify clinical trials that randomly...

  • Postoperative Management of Hip Fractures. Andrews, Neil A. // IBMS BoneKEy;Feb2009, p55 

    The article focuses on the challenges facing clinicians in the U.S. in managing patients who have experienced hip fractures. Despite the extent of the problem of hip fracture and their associated costs, morbidity and mortality, there is evidence to support the use of bisphosphonates in...

  • Use of- Ender's nails in unstable trochanteric femoral fractures. Marsh, C. H. // Journal of the Royal Society of Medicine;Jul1983, Vol. 76 Issue 7, p550 

    Eighty consecutive patients with unstable trochanteric femoral fractures treated by the Ender technique have been studied. Early fixation failure was seen in 18% of patients. Leg shortening and external rotation deformities due to uncontrolled fragmentary collapse were found in almost 80% of the...

  • The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study.  // Journal of Orthopaedic Surgery & Research;2011, Vol. 6 Issue 1, p50 

    The article reports on a research related to the use of calcar screw in the angular stable plate fixation in fractures of the proximal humerus. It states that the difference in the measurement of height between humeral head and the proximal end of the plate are determined. It also informs that...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics