COMPARISION OF FUNCTIONAL OUTCOMES OF VOLAR PLATING VERSUS CONSERVATIVE TREATMENT IN DISTAL RADIUS FRACTURES- A RANDOMIZED CONTROL TRIAL

Main Article Content

Qaisar Alam
Naeem Ullah
Muhammad Salman
Zulfiqar Ullah
Sajjad Haider

Keywords

Distal radius fractures, cast immobilization and volar locking plating.

Abstract

Objective: To compare the functional and radiological outcomes of volar plating versus conservative treatment for distal radius fractures.


Methodology: This randomized controlled trial was conducted in department of Orthopedics and Trauma, National Institute of Rehabilitation Medicine, Islamabad and Zimri Orthopedic Hospital, Islamabad. 74 cases of closed intraarticular distal radius fracture, were divided in two groups, cast immobilization for 6 weeks (group A)  and open reduction internal fixation with volar locking plating (group B) and were followed over a period of one and a half year from February 2021 to August 2022.


Results: Total of 74 patients were observed, which were divided in two equal groups. Overall Male to female ratio was 1.74:1. The overall average age of the patients was 45.33years+ 15.6SD. Dash score was a little bit low in group A as compared to Group B although insignificant with p- value 0.418. Average volar tilt score in group A was 6.68+1.28SD as compared to 3.31+0.59SD in Group B which was significant.


Conclusion: Operative treatment using open reduction and locking plate fixation volarly is more effective as compared to conservative treatment with closed reduction and cast immobilization of distal radius AO type B and C fractures keeping in view the commonly used radiological and functional parameters.

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References

1. Luokkala T, Laitinen MK, Hevonkorpi TP, Raittio L, Mattila VM, Launonen AP. Distal radius fractures in the elderly population. EFORT Open Rev. 2020;5(6):361-370. doi: 10.1302/2058-5241.5.190060.
2. Lawson A, Naylor JM, Buchbinder R, Ivers R, Balogh ZJ, Smith P, et al. Surgical plating vs closed reduction for fractures in the distal radius in older patients: a randomized clinical trial. JAMA Surg. 2021;156(3):229–237. doi: 10.1001/jamasurg.2020.5672.
3. Ahmed M, Ahmed N, Kumar S, Kumar M, Bux M, Hussain G. Functional outcome of intraarticular fracture of distal radius managed by volar locking plate. Cureus. 2020;12(10):e11271. doi: 10.7759/cureus.11271.
4. Aziz A, Memon AA, Shah I, Hashmi I, Rafi S, Bhatti A. A review on outcomes of distal radius fracture treated with different modes of treatment and rehabilitation. Evidence-based review of distal radius fractures. Pak J Med Dent. 2020;9(2):84-90. doi.org/10.36283/PJMD9-2/015
5. Lee DY, Park YJ, Park JS. A meta-analysis of studies of volar locking plate fixation of distal radius fractures: conventional versus minimally invasive plate osteosynthesis. Clin Orthop Surg. 2019;11(2):208-219. doi: 10.4055/cios.2019.11.2.208.
6. Mauck BM, Swigler CW. Evidence-based review of distal radius fractures. Orthop Clin North Am. 2018;49(2):211-222. doi: 10.1016/j.ocl.2017.12.001
7. Thorninger R, Wæver D, Tjørnild M, Lind M, Rölfing JD. VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years. J Orthop Traumatol. 2022;23(1):54. doi: 10.1186/s10195-022-00673-4
8. Bartl C, Stengel D, Gebhard F, Bruckner T, Study Group ORCHID. The treatment of displaced intra-articular distal radius fractures in elderly patients: A randomized multi-center study (orchid) of open reduction and volar locking plate fixation versus closed reduction and cast immobilization. Dtsch Ärztebl Int. 2014;111(46):779-787. doi: 10.3238/arztebl.2014.0779
9. Caruso G, Tonon F, Gildone A, Andreotti M, Altavilla R, Valentini A, et al. Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial. J Orthop Surg Res. 2019;14(2019):477. doi. https://doi.org/10.1186/s13018-019-1530-1
10. Ali T, Ashraf IU, Qazi SATN, Beigh IA. Distal radius fractures: a prospective study of the clinical and radiological outcomes in surgically managed patients. Int J Res Orthop 2022;8:559-564. doi: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20222186
11. Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskel Disord. 2007;8:48. doi:10.1186/1471-2474-8-48
12. Ehsan A, Stevanovic M. Skeletally mature patients with bilateral distal radius fractures have more associated injuries. Clin Orthop Relat Res. 2010;468:238-242. doi: 10.1007/s11999-009-0869-8
13. Vasenius J. Operative treatment of distal radius fractures. Scand J Surg 2008;97:290-297. doi:10.1177/145749690809700403
14. Lucado AM, Li Z. Static progressive splinting to improve wrist stiffness after distal radius fracture: a prospective, case series study. Physiother Theory Pract 2009;25:297-309. doi: 10.1080/09593980902782389
15. Kateros K, Macheras G, Galanakos SP, Sofianos I, Papakostas I, Papadakis SA. External fixation versus “π” plate for distal radius fractures. J Trauma Acut Care Surg. 2010;68(1):166-172. doi: 10.1097/TA.0b013e3181b0d4be
16. Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury. 2000;31(2):75–79. doi: 10.1016/s0020-1383(99)00207-7

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