Displaced Complete Articular Distal Radius Fractures Clinical Trial
Official title:
Internal Plate Fixation vs. Plaster in Complete Articular Distal Radial Fractures
There is no consensus about the best treatment for patients with displaced complete articular distal radius fractures (AO type C fractures). Despite this lack of consensus and the lack of available literature on comparative data to guide treatment for this patient population, operative treatment with plate fixation has gained popularity. The aim of this study is to compare the functional outcome of open reduction and plate fixation with closed reduction and plaster immobilisation in adult patients (18-75 years) with displaced complete articular distal radius fractures.
Distal radius fractures account for 17% of all fractures diagnosed. Two third of those
fractures are displaced and need to be reduced.
According to the Dutch National Guidelines, displaced distal radius fractures, after adequate
reduction confirmed on X-ray, are best treated nonoperatively with cast immobilization.
Moreover, the AAOS Clinical Practice Guideline only suggest surgical fixation when the
articular step, after reduction, exceeds 2mm. However, both recommendations are based on
studies who did not differentiate between intra- and extra-articular distal radius fractures.
So, no clear consensus about the best treatment for patients with displaced intra-articular
distal radius fractures can be made. Despite this lack of consensus and the lack of available
literature on comparative data to guide treatment for this patient population, a rise in use
of volar plating has been observed.
The goal of open reduction and plate fixation is to restore articular congruity and axial
alignment, and to enable early post-operative movement. Several studies show good
radiological and functional results using the volar locking plate in unstable displaced
distal radius fractures.
No studies have been carried out to assess whether operative treatment with plate fixation is
superior in displaced complete articular distal radius fractures to nonoperative treatment in
patients with these fracture type. Therefore, with this randomized controlled trial the
investigators wish to determine the difference in functional outcome, assessed with the
Patient Related Wrist Evaluation (PRWE), after open reduction and plate fixation compared to
nonoperative treatment with closed reduction and cast immobilization.
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