PMID- 34651093
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220427
IS  - 2472-7245 (Electronic)
IS  - 2472-7245 (Linking)
VI  - 6
IP  - 4
DP  - 2021 Oct-Dec
TI  - Volar Locking Plate Versus Dorsal Locking Nail-Plate Fixation for Dorsally 
      Displaced Unstable Extra-Articular Distal Radial Fractures: Functional and 
      Radiographic Results from a Randomized Controlled Trial.
LID - 10.2106/JBJS.OA.21.00068 [doi]
LID - e21.00068
AB  - The use of low-profile dorsal and volar locking plates for distal radial fracture 
      surgery has improved results and lowered the complication rate compared with 
      older plate designs. The purpose of the present randomized controlled trial was 
      to compare patient-reported outcomes as well as radiographic and functional 
      results between patients who underwent stabilization with a volar locking plate 
      or a dorsal locking nail-plate for the treatment of dorsally displaced unstable 
      extra-articular distal radial fractures. METHODS: One hundred and twenty patients 
      >/=55 years of age were randomized to surgery with either a volar locking plate or 
      a dorsal locking nail-plate and were assessed at 2 weeks, 6 weeks, 3 months, 6 
      months, and 1 year. The primary outcome was the abbreviated version of the 
      Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes 
      were the Patient-Rated Wrist Evaluation (PRWE), EuroQol 5 Dimensions (EQ-5D) 
      index and visual analog scale (VAS), range of motion, grip strength, radiographic 
      measurements, and complication rate. RESULTS: The median age was 66 years (range, 
      55 to 88 years). The rate of follow-up was 97%. There was no clinically important 
      difference between the groups at any point during follow-up. Patients in the 
      volar locking plate group had better mean QuickDASH scores at 6 weeks, 6 months, 
      and 1 year. However, the differences were small (5.8 vs. 11.3 points at 1 year; 
      mean difference, -5.5 points [95% confidence interval (CI), -9.9 to 1.2]; p = 
      0.014), which is lower than any proposed minimum clinically important difference 
      (MCID). The difference in PRWE scores was also lower than the MCID (1.0 vs. 3.5 
      at 1 year; mean difference, -2.5 [95% CI, -4.4 to 0.6]; p = 0.012). The dorsal 
      locking nail-plate group had slightly better restoration of volar tilt (p = 
      0.011). EQ-5D index, EQ-5D VAS, range of motion, grip strength, and complication 
      rates were similar. CONCLUSIONS: We found no clinically relevant difference 
      between the volar locking plate and dorsal locking nail-plate groups after 1 year 
      or in the time period up to 1 year. A dorsal locking nail-plate can therefore be 
      an alternative method for the treatment of these unstable fractures or in cases 
      in which a dorsal approach is preferable over a volar approach. LEVEL OF 
      EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete 
      description of levels of evidence.
CI  - Copyright (c) 2021 The Authors. Published by The Journal of Bone and Joint Surgery, 
      Incorporated. All rights reserved.
FAU - Eikrem, Morten
AU  - Eikrem M
AUID- ORCID: 0000-0001-9567-2894
AD  - Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, 
      Norway.
AD  - Orthopaedic Department, Aalesund Hospital, Moere and Romsdal Hospital Trust, 
      Aalesund, Norway.
AD  - Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 
      Norway.
FAU - Brannsten, Hege
AU  - Brannsten H
AUID- ORCID: 0000-0003-2907-5738
AD  - Department of Radiology, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, 
      Norway.
FAU - Bjorkoy, Dagfinn
AU  - Bjorkoy D
AUID- ORCID: 0000-0001-9958-3848
AD  - Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, 
      Norway.
FAU - Lian, Tom
AU  - Lian T
AUID- ORCID: 0000-0003-0087-5598
AD  - Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, 
      Norway.
AD  - Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 
      Norway.
FAU - Madsen, Jan Erik
AU  - Madsen JE
AUID- ORCID: 0000-0002-9002-1213
AD  - Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 
      Norway.
AD  - Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
FAU - Figved, Wender
AU  - Figved W
AUID- ORCID: 0000-0002-8201-9818
AD  - Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, 
      Norway.
AD  - Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 
      Norway.
LA  - eng
PT  - Journal Article
DEP - 20211012
PL  - United States
TA  - JB JS Open Access
JT  - JB & JS open access
JID - 101726219
PMC - PMC8509916
COIS- Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided 
      with the online version of the article (http://links.lww.com/JBJSOA/A322).
EDAT- 2021/10/16 06:00
MHDA- 2021/10/16 06:01
PMCR- 2021/10/12
CRDT- 2021/10/15 06:40
PHST- 2021/10/15 06:40 [entrez]
PHST- 2021/10/16 06:00 [pubmed]
PHST- 2021/10/16 06:01 [medline]
PHST- 2021/10/12 00:00 [pmc-release]
AID - JBJSOA-D-21-00068 [pii]
AID - 10.2106/JBJS.OA.21.00068 [doi]
PST - epublish
SO  - JB JS Open Access. 2021 Oct 12;6(4):e21.00068. doi: 10.2106/JBJS.OA.21.00068. 
      eCollection 2021 Oct-Dec.