Functional Outcomes for Unstable Distal Radial Fractures Treated with Open Reduction and Internal Fixation or Closed Reduction and Percutaneous Fixation

Author(s): L Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS

Source: J Bone Joint Surg 91(8): 1837-1846, 2009.

Summary:

This article describes a randomized prospective trial comparing treatment options of volar plate versus closed reduction and percutaneous pinning for distal radius fractures.  Emphasis was focused on functional outcomes and early motion compared to casting after fixation of unstable extra-articular and simple intra-articular fractures.  Forty-five patients were randomized into two groups, volar plate (n=23) and pin fixation (n=22), with follow-up at 6, 9, 12 weeks and 1 year.  Outcome measures included range of motion, grip and pinch strength, and DASH scores. 

Patients in the ORIF group had better DASH scores up to 12 weeks, but at 1 year there was no significant difference in scoring between groups.  Greater range of motion and strength was also found in the ORIF group at 6 and 9 weeks.  Patients in the ORIF group were very satisfied with overall wrist function and motion.  Volar plating had better functional results early in the postoperative period and a more rapid return to function.

In this series, open reduction allowed a more rapid return of wrist motion and function.  At one year, no differences were identified, which confirms prior reports that document that early motion after this fracture does not lead to a greater final arc of motion.  In addition, more complications were seen in the pin fixation group (six versus two), and 3 patients required early pin removal due to pin tract infections.  The advent of volar locked plating has clearly changed the standard management of this injury.  It allows for a more rapid functional recovery with less soft-tissue complications than pin and/or external fixation methods.