External Fixation and Adjuvant Pins Versus Volar Locking Plate Fixation in Unstable Distal Radius Fractures: A Randomized, Controlled Study With a 5-Year Follow-Up

Purpose To determine whether volar locking plates (VLP) are superior to external fixation (EF) with adjuvant pins in unstable distal radius fractures after 5 years of follow-up. Methods We randomized 111 unstable distal radius fractures to treatment with either a VLP or EF using adjuvant pins. The patients’ mean age was 54 years (range, 20–84 y). Twenty patients were lost to follow-up. At 5 years, 91 patients (82%) were assessed using the visual analog scale (VAS) pain score, Mayo wrist score, Quick Disabilities of the Arm, Shoulder and Hand ( Quick DASH) questionnaire, range of motion, and radiological evaluation. The Quick DASH score at 5 years was the primary outcome measure. Results The Quick DASH score was not statistically significantly different between the groups (VLP 10 vs EF 13) at 5 years. Patients with VLP had statistically significant better supination (85° vs 81°), better radial deviation (18° vs 16°), and less radial shortening (1 mm vs 2 mm). For AO/OTA type C2 fractures, the VLP had statistically significant better supination (84° vs 78°), flexion (64° vs 56°), grip strength (34 kg vs 28 kg), Mayo wrist score (92 vs 76), and less ulnar shortening (1 mm vs 3 mm). The Quick DASH score in the C2 subset analysis showed a difference of 10 (VLP 8 vs EF 18), but this was not statistically significant. In the VLP group, 11 patients (21%) had their plates removed owing to surgically related complications. In the EF group, 5 patients had proximal radial scar correction surgery owing to skin contracture. Conclusions The findings were satisfactory for both groups at 5 years. The VLP provided statistically significantly better results for several clinical outcomes in the C2 subset analysis. However, 21% of the VLPs were removed because of surgical complications. Type of study/level of evidence Therapeutic I.