Randomized comparison of volar locking plates and intramedullary nails for unstable distal radius fractures

J Hand Surg Am. 2015 Jun;40(6):1095-101. doi: 10.1016/j.jhsa.2015.02.014. Epub 2015 Mar 31.

Abstract

Purpose: To compare minimally invasive intramedullary nails (IMN) and volar locking plates (VLP) for the treatment of unstable distal radius fractures by evaluating postoperative subjective, radiographic, and functional outcomes. The hypothesis was that IMN patients would have less pain and required less pain medication in the early postoperative period and returned to work earlier than VLP patients.

Methods: Sixty patients with closed, displaced, unstable, extra-articular, metaphyseal fractures of the distal radius were randomized to receive a VLP or an IMN for internal fixation. Functional outcomes (Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Questionnaire), radiographic measurements (ulnar variance, radial height, inclination, and volar tilt), and range of motion were assessed until final follow-up at 2 years after surgery. Narcotic pain medication use was documented for 5 weeks following surgery.

Results: There were 2 groups of 30 patients with IMN (mean age, 55 ± 14 y) or VLP (mean age, 55 ± 16 y) with similar demographics and comorbidities. Patients with IMN regained extension earlier but had similar range of motion to patients with VLP at final follow-up. There was similar improvement in Michigan Hand Questionnaire, Quick Disabilities of the Arm, Shoulder, and Hand, and strength between groups. Five weeks after surgery, fewer IMN patients required narcotic pain medication (13%) than VLP patients (33%). Radiographic outcomes were similar at final follow-up. There were 3 failures with IMN versus 1 failure with VLP. All 10 employed patients with IMN returned to previous work compared with 10 of the 12 employed patients with VLP. Time to return to work was similar for both groups.

Conclusions: In a cohort of similar patients, IMN and VLP provided comparable improvement in functional and radiographic outcomes. Patients with IMN required less narcotic pain medication after surgery than VLP patients.

Type of study/level of evidence: Therapeutic II.

Keywords: Forearm; open reduction internal fixation.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / therapeutic use
  • Bone Nails*
  • Bone Plates*
  • Disability Evaluation
  • Drug Utilization / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Fracture Fixation, Intramedullary / instrumentation*
  • Fractures, Closed / surgery
  • Humans
  • Joint Instability / surgery*
  • Male
  • Middle Aged
  • Pain, Postoperative / drug therapy
  • Prospective Studies
  • Radius Fractures / surgery*
  • Range of Motion, Articular
  • Return to Work / statistics & numerical data
  • Wrist Joint / surgery
  • Young Adult

Substances

  • Analgesics, Opioid