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Volar Plate Fixation Versus Cast Immobilization in Acceptably Reduced Intra-Articular Distal Radial Fractures: A
C A Selles1,2, M A M Mulders1, J Winkelhagen3
1Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
Surgical treatment for distal radius fractures leads to better functional outcomes than nonoperative care. Operative treatment resulted in improved wrist function scores over 12 months, with fewer patients requiring subsequent surgery.
Area of Science:
- Orthopedic surgery
- Traumatology
- Evidence-based medicine
Background:
- Intra-articular distal radial fractures with acceptable reduction lack conclusive treatment evidence.
- Comparison of nonoperative (cast immobilization) versus operative (volar plate fixation) management is needed.
Purpose of the Study:
- To compare functional outcomes between nonoperative and operative treatments for distal radius fractures.
- To evaluate patient-reported outcomes and clinical measures at 12 months.
Main Methods:
- Multicenter randomized controlled trial involving 96 adult patients.
- Randomization to nonoperative or operative treatment groups.
- Primary outcome: Patient-Rated Wrist Evaluation (PRWE) score at 12 months; secondary outcomes included DASH, SF-36, pain, range of motion, grip strength, and radiographic parameters.
Main Results:
- 90 patients (46 nonoperative, 44 operative) analyzed.
- Operative group showed significantly better PRWE scores at all follow-up points (6 weeks, 3 months, 6 months, 1 year).
- The nonoperative group had a 28% rate of subsequent surgery.
Conclusions:
- Operative treatment (volar plate fixation) yields superior functional outcomes for distal radius fractures compared to nonoperative management.
- Surgical intervention is recommended for adult patients with acceptably reduced intra-articular distal radial fractures.
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