©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial
Herwig Drobetz, Paula Jeffries, Orthopaedic Department, Mackay Base Hospital, James Cook University School of Medicine and Dentistry, Mackay, QLD 4740, Australia
Lidia Koval, Orthopaedic Department, the Prince Charles Hospital, Brisbane, QLD 4032, Australia
Patrick Weninger, Orthopaedic Hospital Speising, Vienna 1130, Austria
Ruth Luscombe, Mathematical Science School, Queensland University of Technology, Brisbane, QLD 4000, Australia
Stefan Ehrendorfer, Orthopaedic Department, Kantons Hospital Uri, 6460 Altdorf, Switzerland
Clare Heal, Department of General Practice, Mackay Base Hospital, James Cook University School of Medicine and Dentistry, Mackay, QLD 4740, Australia
Clare Heal, Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD 4740, Australia
Author contributions: Drobetz H and Koval L designed this study; Koval L and Jeffries P collected data; Luscombe R conducted data analysis; all authors contributed to data analysis and interpretation; Heal C performed the statistical analysis and language editing; all authors drafted the manuscript and approved the final version.
Institutional review board statement: The study was approved by the Queensland Health ethics committee (approval number EC00407).
Clinical trial registration statement: The study was registered with Clinical Trials.gov (NCT00809861; DCDRS00407).
Informed consent statement: All study participants or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: There are no conflicts of interest declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Herwig Drobetz, MD, PhD, FAOrthA, FRACS, Orthopaedic Department, Mackay Base Hospital, James Cook University School of Medicine and Dentistry, Mackay Hospital and Health District, Bridge Road, Mackay, QLD 4740, Australia. firstname.lastname@example.org
Received: May 26, 2016
Peer-review started: May 27, 2016
First decision: July 6, 2016
Revised: July 27, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 18, 2016
To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.
A prospective, randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate (n = 29), or another treatment modality (n = 27; cast immobilisation with or without wires or external fixator). Outcomes were measured at 12 wk. Functional outcome scores measured were the Patient-Rated Wrist Evaluation (PRWE) Score; Disabilities of the Arm, Shoulder and Hand and activities of daily living (ADLs). Clinical outcomes were wrist range of motion and grip strength. Radiographic parameters were volar inclination and ulnar variance.
Patients in the volar locking plate group had significantly better PRWE scores, ADL scores, grip strength and range of extension at three months compared with the control group. All radiological parameters were significantly better in the volar locking plate group at 3 mo.
The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities. Anatomical reduction was significantly more likely to be preserved in the plating group. Level of evidence: II.
Core tip: The present study suggests that the treatment of distal radius fractures with volar locking distal radius plates and immediate postoperative mobilisation produces better functional, radiological and clinical outcomes at three months compared with other treatment modalities which necessitate six weeks immobilisation post fracture. Short term outcomes are very important in our view, as early mobility potentially means earlier return to activities of daily life and return to work for younger patients and remaining functionally independent for the elderly. Future studies should focus on cost savings gained by earlier return to activities of daily living.