Volar Locking Plate or External Fixation with Optional Addition of K-wires for Dorsally Displaced Distal Radius Fractures: A Randomized Controlled Study.

Objectives: To compare the outcomes after open reduction and fixation with a volar locking plate or external fixation with optional addition of K-wires in patients aged 50-74 years. Design: Randomized controlled trial according to the Consolidated Standards of Reporting Trials criteria. Setting: Single-center second-level trauma center in the capital of Sweden. Patients: One hundred forty patients presenting with a dorsally displaced distal radius fracture were randomized to fixation with a volar locking plate (n = 70) or external fixation with optional addition of K-wires (n = 70). Main Outcome Measurement: The primary outcome was the Disability of the Arm, Shoulder, and Hand (DASH) at 12 months. EuroQol-5D, radiography, and recordings of complications were performed at 2 and 6 weeks and at 3 and 12 months. Patients were investigated for DASH, the Patient-Rated Wrist Evaluation, range of motion, and grip strength at 3 and 12 months. Results: There were no significant differences between the groups in terms of DASH and Patient-Rated Wrist Evaluation at 3 months and 1 year (P > 0.05). EuroQol-5D was lower during the first 6 weeks in the external fixation group (P < 0.05), but the difference was no longer significant at 3 months. Radiographic restoration of alignment was better for the volar locking plate group in terms of volar tilt and radial length. The range of motion was equal in both groups except for radial deviation, which was better in the volar locking plate group at 1-year follow-up. The total rate of complications was equal for both groups. Conclusions: Volar plating and external fixation with optional addition of K-wires are 2 equally suitable treatment options for dorsally displaced distal radius fractures after low-energy trauma in a population aged 50-74 years. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.