Percutaneous pinning vs. internal fixation with locking plate: Postoperative results of comminuted fractures of the distal radius metaphysis. A randomised controlled trial

Abstract

Background: There is controversy surrounding the treatment of distal metaphyseal fractures of the radius. This has increased even more with the advent of fixation with locking plates and its notable increasing preference by surgeons in recent years, although its benefits have not yet been demonstrated in extra-articular fractures. This has led us to conduct a study that would enable us to define the best treatment method for this group of fractures.
Materials and methods: A controlled clinical trial was conducted in order to compare two methods of fixation of distal, extra-articular, radius fracture in adults. One group consisted of patients treated with closed reduction and percutaneous fixation (group 0), and a second group treated with open reduction and internal fixation with locked plate via volar approach (group 1). Radiological assessment, including clinical monitoring, was performed at 6 weeks and up to 52 weeks.
Results: A total of ¿67? patients (group: 36; group 1: 31) were included. Follow-up at 6 and 12 weeks were acceptable, but there was a high number of patients that were lost to follow-up at 26 and 52 weeks. There were no differences between the two groups in terms of consolidation and reduction quality, but there were differences in the strength and mobility advantage for open reduction and internal fixation.
Discussion: The study failed to show similar radiological and clinical outcomes for the two groups in the short-term. There were no significant differences in complications. A significant difference was demonstrated statistically in cost advantage for closed reduction and percutaneous fixation. Loss to follow-up limits us to draw conclusions about the outcome in the medium and long term, and therefore no recommendations are offered.
Evidence level: II.