Functional Outcomes for Unstable Distal Radial Fractures Treated with Open Reduction and Internal Fixation or Closed Reduction and Percutaneous Fixation: A Prospective Randomized Trial

UPDATEThis article was updated on November 21, 2014, because of a previous error. In Table III, the units for grip strength and pinch strength were identified as the mean, in kilograms, with the percentage of the value for the uninjured side in parentheses. They have now been identified as the percentage of the contralateral side (mean and standard deviation). The original values of 22 (21%), 12 (30%), 28 (18%), 17 (24%), 29 (19%), 32 (63%), 40 (19%), and 41 (60%) for grip strength at six weeks, nine weeks, twelve weeks, and one year have been replaced with the following values49.3 ± 20.9, 25.6 ± 30.1, 62.5 ± 18.2, 36.6 ± 23.7, 64.5 ± 18.5, 69.8 ± 63.0, 87.9 ± 19.2, and 90.2 ± 59.6. The original values of 27 (26%), 18 (27%), 33 (17%), 25 (25%), 38 (17%), 34 (22%), 44 (40%), and 40 (27%) for pinch strength at six weeks, nine weeks, twelve weeks, and one year have been replaced with the following values59.1 ± 25.8, 38.8 ± 27.0, 72.0 ± 17.2, 54.8 ± 25.4, 83.4 ± 16.8, 76.0 ± 22.4, 96.9 ± 39.8, and 87.4 ± 26.7.BackgroundDespite the recent trend toward internal fixation of distal radial fractures, few randomized trials have examined whether volar plate fixation is superior to other stabilization techniques. The purpose of the present study was to compare (1) open reduction and internal fixation with use of a volar plate and early mobilization with (2) percutaneous fixation and casting or external fixation for the treatment of dorsally displaced unstable extra-articular and simple intra-articular fractures of the distal part of the radius, with a specific emphasis on early functional recovery.MethodsA prospective randomized study was performed at two institutions. Forty-five consecutive patients with a displaced, unstable fracture of the distal part of the radius were randomized to closed reduction and pin fixation (n = 22) or open reduction and internal fixation with a volar plate (n = 23). Clinical and radiographic assessments were conducted at six, nine, and twelve weeks after surgery and at one year. Outcome was measured on the basis of range of motion; grip and pinch strength; and Disabilities of the Arm, Shoulder and Hand scores. A questionnaire was used to determine patient satisfaction, and a detailed analysis of complications was performed.ResultsPatients in the open reduction and internal fixation group had superior Disabilities of the Arm, Shoulder and Hand scores at six, nine, and twelve weeks. At six weeks, the average Disabilities of the Arm, Should