RCT comparing closed reduction and percutaneous versus open reduction and volar locking plate in treatment of distal radius fractures in adults
Journal Title: International Journal of Orthopaedics Sciences - Year 2017, Vol 3, Issue 2
Abstract
Introduction: Displaced distal radius fractures are very common injuries and present regularly to all orthopaedic surgeons. Several documented treatment modalities for these fractures have been described with a recent trend for internal fixation with volar plating. However, the literature suggests that there is still no consensus as to the best treatment of these injuries. Distal radius fractures are among the most common bone fractures all over the world. Close reduction and fixation by percutaneous pinning is a less invasive method comparing with other open surgeries. There is still a dearth of prospective randomized trials in this area. Before the advent of volar locking plates the randomized trials for surgical interventions for distal radius fractures show some evidence to support the use of external fixation or percutaneous pinning however their precise role and methods are not established and whether this will produce consistently better long-term outcome is also not clear. Aim & Objective: To compare percutaneous pinning versus volar locking plate in treatment of distal radius fractures in adults in term of: fracture union, post operative pain, functunal outcome, post operative complication (stiffness, CRPS). Materials and Methods: It is Randomised Controlled Trial Study. All Adults Patients aged 16 and above with displaced distal radius fractures fpresented to the Emergency department and out Patient Department of Orthopaedics at BPKIHS from August 2010 to September 2012 were included in the study. Results: 60 patients with fracture distal end of radius who met the inclusion criteria were included in the study, out of which 30 were randamized into group A, treated by closed reduction and percutaneous fixation supplemented by cast and 30 in group B, treated by volar locking plate. The study showed mean age of incidence to be 39.22+- 14.49 years in age group ranging from 16-65 years. In our study we found that the injuries were result of high energy trauma with RTA constituting the commonest mode of injury (75%) followed by fall from height (15%) and play ground injuries (10%). Males constituted the majority of the study population(67%). Age, sex, mode of injury, type of fracture, interval to surgery duration and associated co-morbidities were equally distributed between the two groups showing success of randamization. There was a highly significant diference in the operative ime and blood loss between two groups, illustating that percutaneous fixation is much shorter procedure with mean operative time of 30 mins compared to 60mins of ORIF with volar locking plate and has less blood loss being 5-10ml to 145ml of ORIF with volar plating. Conclusion: ORIF with volar locking plating provide better radilogical outcomes with more stable fixation thus lesser degree of loss of reduction in comparation to percutaneous pinning. It also had better ROM at wrist initially however this difference is not significant in later months. Volar locking plate is more expensive with more operative time and blood loss as compared to pinning.
Authors and Affiliations
Chaudhary P, Shrestha BP, Khanal GK, Baral P, Shah AB, Das J
Keywords
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- EP ID EP502609
- DOI 10.22271/ortho.2017.v3.i2g.70
- Views 81
- Downloads 0
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