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Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures: A Randomized Controlled Study of 150 Cases
Örebro University, School of Medical Sciences. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-4288-3134
Örebro University, School of Medical Sciences. Department of Orthopedics, Karlstad Central Hospital, Karlstad, Region Värmland, Sweden.
Örebro University, School of Medical Sciences. Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Region Västernorrland, Sundsvall, Sweden.
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2022 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 47, no 9, p. 813-822Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating.

METHODS: In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score.

RESULTS: Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group.

CONCLUSIONS: In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Place, publisher, year, edition, pages
Elsevier, 2022. Vol. 47, no 9, p. 813-822
Keywords [en]
Articular, distal radius fractures, dorsal plate, outcomes, trauma
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-100604DOI: 10.1016/j.jhsa.2022.04.018ISI: 000863114200004PubMedID: 35842329Scopus ID: 2-s2.0-85134759998OAI: oai:DiVA.org:oru-100604DiVA, id: diva2:1687444
Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2022-11-09Bibliographically approved
In thesis
1. Distal radius fractures AO type C: A clinical and radiographic investigation
Open this publication in new window or tab >>Distal radius fractures AO type C: A clinical and radiographic investigation
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The function of the hand is of substantial importance, and injuries have an impact on daily life. Distal radius fracture (DRF) is the most common fracture among adults. The annual incidence is 26 per 10,000 inhabitants, and the incidence is increasing because of an aging population. There has been a shift from conservative and other operative treatments, toward volar plate fixation to restore the anatomy and improve results. Operative treatment is often considered for displaced and unstable fractures. The optimal choice of treatment and fixation is still debated. The aim of this thesis was to study results after internal fixation of DRF AO type C.

Study I (retrospective study, n=74) assessed outcomes after combined plating (CP) of DRFs AO type C, with 1-year follow-up. CP restored the anatomy and achieved a good functional outcome. The radiographic outcome did not correspond to the clinical or functional outcome.

Study II (prospective study, n=97) assessed the prevalence of post-traumatic arthritis (PA) following CP of DRFs AO type C. CP yielded a good clinical outcome 7 years postoperatively and the prevalence of PA was low (29%). The presence of PA did not correlate with fracture group, radio-graphic, clinical, or functional outcome. 

Study III (randomized controlled trial, n=147) assessed the radiographic and clinical outcome following surgical treatment of DRFs AO type C, comparing volar plating (VP) with CP. Fixation with VP yieldedthe same radiographic and functional results as CP, but with a lower frequency of complications in the VP group.

Study IV (prospective pilot study, n=10) assessed fragment migration with CTMA (CT-based micromotion analysis) after osteosynthesis with VP after DRF AO type C. The CTMA technique indicated that variable angle volar locking plate fixation can yield and maintain a stable reduction of the fracture fragments. CT volume registration could be a valuable tool in the detailed assessment of fracture fragment migration following VP fixation of DRFs. 

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 93
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 272
Keywords
Distal radius fracture, patient-reported outcome measures, functional outcome, radiographic outcome, plating, volar locking plate, combined plating, surgical treatment, post-traumatic arthritis, wrist
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-101432 (URN)9789175294742 (ISBN)
Public defence
2022-12-02, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
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Available from: 2022-09-23 Created: 2022-09-23 Last updated: 2022-11-14Bibliographically approved

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Lundqvist, EvaFischer, PerWretenberg, PerSagerfors, Marcus

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