Use of volar locking plates and immediate mobilization for the treatment of distal radius fractures demonstrated greater improvement in functional, radiographic, and clinical scores compared with other treatment modalities, including casting and external fixation with 6 weeks of immobilization. Lidia Koval, MBBS, Mackay Base Hospital, West Mackay, Australia, presented data from a trial evaluating the use of a volar locking plate vs an external fixator or cast fixation in patients with a distal radius fracture.

Although the long-term outcomes associated with the treatment of distal radius fractures are similar across modalities, short-term outcomes are not well understood. Immediate immobilization of the wrists is important, yet it is inconvenient to the patient because it can cause loss of income and loss of independence. Therefore, regaining mobilization early is important. The purpose of this study was to evaluate the short-term outcomes of volar locking plates and immediate postoperative mobilization compared with conservative treatment with an external fixator and 6 weeks of immobilization in patients with a distal radius fracture.

In this prospective, single-center study, 50 patients with distal radius fracture who were recruited from 5 orthopaedic surgeons were randomly assigned to receive a volar locking plate with immediate mobilization postoperation, or casting or external fixator with or without Kirschner wires (K-wires) plus immobilization for 6 weeks postoperation. Functional outcomes were measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Patient-Rated Wrist Evaluation (PRWE) score. Clinical scores included range of motion, grip strength, and activities of daily living (ADLs), and radiologic outcomes were measured by radiography.

In the volar locking plate arm, the DASH score was lower (P = .063) and the PRWE was significantly lower (P = .007) compared with the immobilized arm. In addition, patients who received the volar locking plate demonstrated significantly greater grip strength compared with the immobilized arm (P = .012). Patients in the volar locking plate arm also demonstrated significantly improved ADLs compared with patients in the immobilized arm (P = .036). Radiologic evidence demonstrated that volar slope both after reduction and at follow-up was significantly better in the volar locking arm compared with the immobilized arm (P = .01 and P = .001). In addition, radial inclination and ulnar variance were also improved in patients who received the volar locking plate compared with patients in the immobilized arm.

Complications in the volar locking plate arm included complex regional pain syndrome (CRPS), flexor tendon rupture, carpal tunnel syndrome, and requests to remove plates. In the immobilized arm, complications included malunion (1 of which was treated with corrective osteotomy), CRPS, and infection of K-wires.

In conclusion, Prof Koval stated that the results of this study suggest that the short-term outcomes associated with the use of a volar locking plate for the treatment of distal radius fractures were superior to those of other treatment modalities. However, a cost-savings analysis is needed to determine if earlier return to ADLs with volar locking plate treatment provides a cost savings over other modalities.

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