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
|Author:||Sirniö, Kai1; Leppilahti, Juhana1; Ohtonen, Pasi2;|
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
|Online Access:||PDF Full Text (PDF, 0.2 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2019102534692
|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.
|Pages:||123 - 128|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
3126 Surgery, anesthesiology, intensive care, radiology
© 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 (https://creativecommons.org/licenses/by/4.0).