PAPER 198: A PROSPECTIVE, RANDOMIZED, CLINICAL TRIAL ON UNSTABLE DISTAL RADIUS FRACTURES: EXTERNAL FIXATION VERSUS VOLAR PLATING VERSUS RADIAL COLUMN PLATING

Abstract

Purpose: Distal radius fractures are common and rising in incidence as orthopaedists treat an increasingly aged population. Both external fixation and volar plating have demonstrated satisfactory results, however the orthopaedic literature lacks comparative data on radial column plating. The purpose of this prospective study was to compare functional and radiographic data from patients randomized to three surgical modalities – external fixation, volar plating, and radial column plating.

Method: This study included 40 patients with closed, unilateral, unstable distal radius fractures distributed as follows: 20 patients treated with external fixation, 10 patients with volar plating, and 10 patients with radial column plating. When classified according to the OTA system, the fractures included types A3, B3, and C1 C3. Patients were followed post-operatively at 2, 4, 6, 12, 24, and 52 weeks. At each visit, patients completed a DASH questionnaire, grip and lateral pinch strength, and range of motion for both wrists. Radiographs were evaluated for lateral tilt, radial inclination, ulnar variance and radial height. Statistical analyses employed single-factor three-way ANOVA of all outcomes at each follow-up period.

Results: No significant difference (p> 0.05) was found between mean DASH scores at each follow-up period for all three patient groups. However, each group achieved significant improvement in DASH scores at 1-year follow-up compared to baseline scores (external fixation, p0.05), with final flexion-extension and supination-pronation ranging 78–94% and 92–96% (of the un-injured wrist), respectively. All radiographic measurements demonstrated no significant differences. Reduction was maintained among all three groups without implant failure or complications.

Conclusion: At all follow-up periods, analysis of functional and radiographic outcomes showed no significant difference among all groups. Based on this data, no one method of fixation is superior to the others, giving orthopaedists multiple options for surgically reducing the unstable distal radius. Moreover, the diversity in approach of these methods allows additional flexibility in selecting an appropriate technique for each patient.