Volar Locking Plate Versus Dorsal Locking Nail-Plate Fixation for Dorsally Displaced Unstable Extra-Articular Distal Radial Fractures: Functional and Radiographic Results from a Randomized Controlled Trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(22):8 JB JS Open Access. 2021 Oct 12;6(4): e21.00068.What this means for my practice?
Results of this study found that volar plating provides significant advantages over dorsal nail-plating with respect to upper-limb function up to 1 year post-operation, as well as significantly less pain and greater grip strength early post-operation. However, none of the differences between groups in patient-reported outcomes were clinically important. This study was limited by the lack of blinding of the study nurse and physiotherapist, and the difference in scarring which may have revealed treatment allocation.
Study Summary
One hundred and twenty patients with dorsally-displaced, unstable, extra-articular distal radius fractures were randomized to receive fracture fixation using a volar locking plate (n=60) or a dorsal locking nail-plate (n=60). The primary outcome of interest was the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score. Secondary outcomes of interest included the Patient-Rated Wrist Evaluation (PRWE), EuroQoL 5 Dimensions (EQ-5D) index and Visual Analog Scale (VAS) scores, pain medication use, range of motion, grip strength, and radiographic outcomes. Outcomes were assessed up to 1 year post-operation. Results demonstrated significantly favourable QuickDASH and PRWE scores in the volar plate up to 1 year post-operation, however these differences were not clinically important. Lower need for pain medication and greater grip strength were observed in the volar plating group in the first 6 weeks post-operation.
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