External Fixation and Adjuvant Pins Versus Volar Locking Plates in Unstable Distal Radius Fractures: A Randomized...

To investigate if volar locking plates (VLPs) are superior to external fixation (EF) with adjuvant pins in unstable distal radius fractures after 10 years of follow-up.

From 2007 to 2009, 111 unstable distal radius fractures were randomized to either EF or VLP. The patients' mean age was 54 years (20-84). At 10 years, 86 patients (77%) were assessed (VLP 43, EF 43). Eighty-one patients (VLP 42, EF 39) had a clinical and radiological examination. Five patients (EF 4, VLP 1) refused to attend the examination, but returned the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. There were 70 women and 16 men with 2 A2, 21 A3, 35 C1, 25 C2, and 3 C3 fractures (AO/ASIF). The patients were assessed clinically by using the visual analog scale pain score at rest/activity, Mayo wrist score, QuickDASH questionnaire, and range of motion. Complications were registered during the study period. The QuickDASH score at 10 years was the primary outcome measure.

The QuickDASH score was not significantly different between the groups, with a mean score of 9 in the VLP and 10 in the EF. The final QuickDASH scores were lower than the normative values in this age group. There were no clinically relevant differences in the visual analog scale pain score, Mayo wrist score, and range of motion. There was less radial shortening in the VLP group. The C-type fractures demonstrated no significant clinical differences, but there were more cases of radiological osteoarthritis in the EF group. Nineteen patients had their VLPs removed because of hardware problems.

There were good clinical results in both groups at 10 years, but there is a concern that 19 patients had to have the VLPs removed.

Therapeutic I.