Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(9):10 JAMA Surg. 2021 Mar 1;156(3): 229-237.What this means for my practice?
Results of this randomized controlled trial suggest that for patients suffering from distal radius fractures, undergoing surgery for fixation and open reduction using a volar-locking plate can provide similar results for patient-reported pain and function at 1-year post-treatment compared to cast immobilization. However, this study was limited by the lack of blinding of patients which could have increased bias since the primary outcome was patient-reported. Furthermore, outcomes utilized were subjective and not objective, which could have also increased bias. Therefore, future randomized controlled trials implementing blinding of patients as well as utilizing objective outcome measures are needed to confirm the findings of this trial.
Study Summary
One hundred and sixty-six patients who sustained displaced distal radius fractures were randomized to undergo an open reduction and internal fixation procedure using a volar-locking plate (VLP; n=81) or conservative management through closed reduction and cast immobilization (n=85). The primary outcome of interest was pain and function measured using the Patient-Rated Wrist Evaluation (PRWE) at 12 months post-treatment. Results revealed that the PRWE scores at 12 months follow-up were not significantly different between the 2 groups.
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