Volar Locking-Plate and Kirschner-Wire Fixation Did Not Differ in Terms of Functional Outcomes After Dorsally Displaced Distal Radial Fracture

BackgroundIn high-income countries, 6% of all women will have sustained a fracture of the wrist (distal radius) by the age of 80 years and 9% by the age of 90 years. Advances in orthopaedic surgery have improved the outcome for patients: many such fractures can be treated in a plaster cast alone, but others require surgical fixation to hold the bone in place while they heal. The existing evidence suggests that modern locking-plate fixation provides improved functional outcomes, but costs more than traditional wire fixation.MethodsIn this multicentre trial, we randomly assigned 461 adult patients having surgery for an acute dorsally displaced fracture of the distal radius to either percutaneous Kirschner-wire fixation or locking-plate fixation. The primary outcome measure was the Patient-Rated Wrist Evaluation©(PRWE) questionnaire at 12 months after the fracture. In this surgical trial, neither the patients nor the surgeons could be blind to the intervention. We also collected information on complications and combined costs and quality-adjusted life-years (QALYs) to assess cost-effectiveness.ResultsThe baseline characteristics of the two groups were well balanced and over 90% of patients completed follow-up. Both groups of patients recovered wrist function by 12 months. There was no clinically relevant difference in the PRWE questionnaire score at 3 months, 6 months or 12 months [difference at 12 months: –1.3; 95% confidence interval (CI) –4.5 to 1.8;p = 0.398]. There was no difference in the number of complications in each group and small differences in QALY gains (0.008; 95% CI –0.001 to 0.018); Kirschner-wire fixation represents a cost-saving intervention (–£727; 95% CI –£588 to –£865), particularly in younger patients.ConclusionsContrary to the existing literature, and against the increasing use of locking-plate fixation, this trial shows that there is no difference between Kirschner wires and volar locking plates for patients with dorsally displaced fractures of the distal radius. A Kirschner-wire fixation is less expensive and quicker to perform.Trial registrationCurrent Controlled Trials ISRCTN31379280.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 17. See the NIHR Journals Library website for further project information.

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Factors predictive for union of basal fracture of the ulnar styloid process after distal radial fracture fixation using a volar locking plate

Injury ◽

10.1016/j.injury.2020.10.088 ◽

2020 ◽

Author(s):

Soo Min Cha ◽

Hyun Dae Shin ◽

Seung Hoo Lee ◽

In Ho Ga

Keyword(s):

Fracture Fixation ◽

Locking Plate ◽

Styloid Process ◽

Distal Radial Fracture ◽

Volar Locking Plate ◽

Radial Fracture ◽

Ulnar Styloid ◽

Ulnar Styloid Process

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Correlation between patient-reported outcome measures and Single Assessment Numerical Evaluation score in patients treated with a volar locking plate for a distal radial fracture

The Bone & Joint Journal ◽

10.1302/0301-620x.102b6.bjj-2019-0859.r2 ◽

2020 ◽

Vol 102-B (6) ◽

pp. 744-748

Author(s):

Wan-Sun Choi ◽

Ji Sun Hwang ◽

Jae-Seung Hur ◽

Chang-Hun Lee ◽

Joo-Hak Kim ◽

...

Keyword(s):

Correlation Coefficient ◽

Numerical Evaluation ◽

Locking Plate ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Distal Radial Fracture ◽

Volar Locking Plate ◽

Radial Fracture ◽

Patient Reported

Aims The aim of this study was to compare patient-reported outcome measures (PROMs) and the Single Assessment Numerical Evaluation (SANE) score in patients treated with a volar locking plate for a distal radial fracture. Methods This study was a retrospective review of a prospective database of 155 patients who underwent internal fixation with a volar locking plate for a distal radial fracture between August 2014 and April 2017. Data which were collected included postoperative PROMs (Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE)), and SANE scores at one month (n = 153), two months (n = 155), three months (n = 144), six months (n = 128), and one year (n = 73) after operation. Patients with incomplete data were excluded from this study. Correlation and agreement between PROMs and SANE scores were evaluated. Subgroup analyses were carried out to identify correlations according to variables such as age, the length of follow-up, and subcategories of the PRWE score. Results The Pearson correlation coefficient (r) between PROMs and SANE scores was -0.76 (p < 0.001) for DASH and -0.72 (p < 0.001) for PRWE, respectively. Limits of agreement between PROMs and ‘100-SANE’ scores were met for at least 93% of the data points. In subgroup analysis, there were significant negative correlations between PROMs and SANE scores for all age groups and for follow-up of more than six months. The correlation coefficient between PRWE subcategories and SANE score was -0.67 (p < 0.001) for PRWE pain score and -0.69 (p < 0.001) for PRWE function score, respectively. Conclusion We found a significant correlation between postoperative SANE and PROMs in patients treated with a volar locking plate for a distal radial fracture. The SANE score is thus a reliable indicator of outcome for patients who undergo surgical treatment for a radial fracture. Cite this article: Bone Joint J 2020;102-B(6):744–748.

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Return of function following dorsally displaced distal radial fracture managed with a volar locking plate

Injury Extra ◽

10.1016/j.injury.2006.12.106 ◽

2007 ◽

Vol 38 (4) ◽

pp. 138

Author(s):

L. McCullough ◽

C. Carnegie ◽

E. Christie ◽

A. Johnstone

Keyword(s):

Locking Plate ◽

Distal Radial Fracture ◽

Volar Locking Plate ◽

Radial Fracture

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Scaphoid Dislocation Reconstruction with Scapholunotriquetral Ligament Tenodesis

Journal of Wrist Surgery ◽

10.1055/s-0041-1735884 ◽

2021 ◽

Author(s):

Brian Mailey ◽

Amanda L. Brown ◽

James Winters

Keyword(s):

Literature Review ◽

Range Of Motion ◽

Functional Outcomes ◽

Kirschner Wire ◽

Injury Pattern ◽

Traumatic Injuries ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Surgical Treatments

AbstractTraumatic injuries leading to complex scaphoid dislocations are uncommon. We present a successful reconstructive case after a complex intercarpal instability injury using scapholunotriquetral tenodesis without the need for Kirschner wire fixation and early controlled range of motion therapy. At 3 months, the patient had a pain-free wrist with a 100-degree arc of motion and returned to work with full functionality. A literature review was performed to describe the previously published surgical treatments of this injury pattern and compare functional outcomes.

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