Similar 6-month outcome between distal and proximal volar locked plates for displaced DRFs

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
72 patients with a displaced distal radius fracture scheduled for fixation with a volar locking plate were randomized to receive a plate placed distal to the watershed line, or a plate placed completely proximal to the watershed line. The purpose of this study was to compare the range of motion, functional outcome measures, and complications between groups over a 6-month follow-up. With the exception Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: None disclosed
Why was this study needed now?
Locking plate fixation is a common method of operative management for displaced distal radius fractures. Despite a number of randomized controlled trials published comparing the efficacy of volar locking plates to other methods of management, very few research studies have been conducted on different methods of plate fixation. More specifically, there has been recent concern that placement of the plate too far distal may disrupt and damage the flexor tendons. This study was performed to compare outcomes of volar plates placed distal to the watershed line versus proximal to the watershed line.
What was the principal research question?
In volar plate fixation of a displaced distal radius fracture, was there any significant difference in functional outcome between two different plate designs; one to be placed distal to the watershed line, and one to be placed proximal to the watershed line?
Population: 72 patients, over 20 years of age, with a displaced AO/OTA type 23 A2-3, B2-3, or C1-3 fracture and requiring internal fixation. All cases were performed through a trans-flexor capri radialis approach. Fluoroscopic guidance was used for insertion of distal locking screws within both groups.
Intervention: Distal plate: Patients received a plate placed distal to the watershed line (AcuLoc; Acumed). (n=36 randomized; 32 analyzed) (Mean age: 62.9+/-14.2)
Comparison: Proximal plate: Patients received a plate placed proximal to the watershed line (VariAx; Stryker). (n=36 randomized; 32 analyzed) (Mean age: 61.5+/-13.9)
Outcomes: Primary outcomes were wrist flexion-extension range of motion, expressed as a percentage of the contralateral wrist, as well as grip strength. Secondary outcomes included patient-reported outcome measures of the Mayo wrist score and the Disability of the Arm, Shoulder, and Hand (DASH) score, incidence of pertinent complications (ie. tendon rupture, carpal tunnel syndrome, and complex regional pain syndrome), and radiographic outcomes. Anteroposterior and lateral radiographs were obtained to assess fracture union/loss of reduction and palmar prominence of the plate. Ultrasound was performed to assess the distance between the flexor pollicus longus tendon and the implant.
Methods: RCT; Patient-blind; Single-center
Time: Follow-up scheduled for 1, 2, 3, and 6 months postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.