Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures: a randomized, controlled study.

PURPOSE: To determine whether volar locking plates are superior to external fixation with adjuvant pins in the treatment of unstable distal radius fractures.

METHODS

A total of 111 unstable distal radius fractures were randomized to treatment with external fixation (EF) using adjuvant pins or with a volar locking plate (VLP). The mean age of the patients was 54 years (range, 20-84 y). Seven patients were lost to follow-up. At 1 year, 104 patients were assessed with a visual analog scale pain score, Mayo wrist score, Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH), range of motion, and radiological evaluation. The QuickDASH score at 52 weeks was the primary outcome measure.

RESULTS

The operative time in the EF group was 77 minutes, compared with 88 minutes in the VLP group. At 52 weeks, patients with VLPs had a higher Mayo wrist score (90 vs. 85), better supination (89° vs. 85°), and less radial shortening (+1.4 mm vs. +2.2 mm). There were more patients with pain over the ulnar styloid in the EF group (16 vs 6 patients). For AO type C2/C3, the patients with VLPs had better supination (90° vs. 76°) and less ulnar shortening (+1.1 mm vs. +2.8 mm). The complication rate was 30% in the EF group, compared with 29% in the VLP group. Eight (15%) plates were removed due to complications. The QuickDASH score was not significantly different between the groups.

CONCLUSIONS

Although we did not find a significant difference between the groups for the QuickDASH score, we believe that our results support the use of VLPs for the treatment of unstable distal radius fractures. A serious concern is that some patients will have to have their plates removed; therefore, improving the surgical technique is important.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.