University of Oulu

Kai Sirniö, Juhana Leppilahti, Pasi Ohtonen & Tapio Flinkkilä (2019) Early palmar plate fixation of distal radius fractures may benefit patients aged 50 years or older: a randomized trial comparing 2 different treatment protocols, Acta Orthopaedica, 90:2, 123-128, DOI: 10.1080/17453674.2018.1561614

Early palmar plate fixation of distal radius fractures may benefit patients aged 50 years or older : a randomized trial comparing 2 different treatment protocols

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Author: Sirniö, Kai1; Leppilahti, Juhana1; Ohtonen, Pasi2;
Organizations: 1Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu
2Department of Anesthesiology, Surgery, and Intensive Care, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: Informa, 2019
Publish Date: 2019-10-25


Background and purpose: There is no consensus regarding optimal treatment of displaced distal radius fractures (DRFs). We compared the results of 2 treatment protocols: early palmar plating vs. primary nonoperative treatment of displaced DRFs.

Patients and methods: We performed a prospective randomized controlled study including 80 patients aged ≥ 50 years with dorsally displaced DRFs, excluding AO type C3 fractures. Patients were randomized to undergo either immediate surgery with palmar plating (n = 38), or initial nonoperative treatment (n = 42) after successful closed reduction in both groups. Delayed surgery was performed in nonoperatively treated patients showing early loss of alignment (n = 16). The primary outcome measure was Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results: Mean DASH scores at 24 months in the early surgery group were 7.9 vs. 14 in the initial nonoperative group (difference between means 6, 95% CI 0.1–11, p = 0.05). Delayed operation was performed on 16/42 of patients due to secondary displacement in the initial nonoperative group. In “as treated” analysis, DASH scores were 7 in the early surgery group, 13 in the nonoperative group, and 17 after delayed surgery (p = 0.02). The difference in DASH scores between early and delayed surgery was 9 points (CI 0.3–19, p = 0.02).

Interpretation: Treatment of DRFs with early palmar plating resulted in better 2-year functional outcomes for ≥50-year-old patients compared with a primary nonoperative treatment protocol. Delayed surgery in case of secondary displacement was not beneficial in terms of function.

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Series: Acta orthopaedica
ISSN: 1745-3674
ISSN-E: 1745-3682
ISSN-L: 1745-3674
Volume: 90
Issue: 2
Pages: 123 - 128
DOI: 10.1080/17453674.2018.1561614
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2019 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (