Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial

Injury. 2011 Feb;42(2):162-6. doi: 10.1016/j.injury.2010.07.236.


Fractures of the distal radius are commonly treated with cast immobilisation; however, those potentially unstable injuries with dorsal comminution may need operative intervention. This intervention is usually with manipulation and Kirschner wires but advances in locking-plate technology have enabled surgeons to achieve anatomical reconstruction of complex fracture patterns, even in poor-quality osteoporotic bone.To ascertain if fixed-angle volar-locked plates confer a significant benefit over manipulation and Kirschner-wire stabilisation, we prospectively randomised 56 adult patients with isolated, closed,unilateral, unstable extra-articular fractures into two treatment groups, one fixed with K-wires and the other fixed with a volar locking plate.Functional outcomes were assessed using Gartland and Werley and Disabilities of the Arm, Shoulder and Hand (DASH) scores. These were statistically better in the plate group at 3 and 6 months.Radiological assessment showed statistically better results at 6 weeks, 3 months and 6 months, postoperatively.In the plate group, there was no significant loss of fracture reduction.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bone Wires*
  • Female
  • Fracture Fixation, Internal / methods*
  • Hand Strength / physiology
  • Humans
  • Male
  • Middle Aged
  • Palmar Plate*
  • Prospective Studies
  • Radius Fractures / physiopathology
  • Radius Fractures / surgery*
  • Range of Motion, Articular / physiology
  • Treatment Outcome
  • Young Adult