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Functional Outcomes for Unstable Distal Radial Fractures Treated with Open Reduction and Internal Fixation or Closed Reduction and Percutaneous Fixation

A Prospective Randomized Trial

¹ Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215. E-mail address for T.D. Rozental: trozenta{at}bidmc.harvard.edu
² Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
³ Harvard Medical School, 25 Shattuck Street, Boston, MA 02115

Investigation performed at the Departments of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Wright Medical. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: A 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.

Results: Patients 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, Shoulder and Hand score was 27 in the open reduction and internal fixation group as compared with 53 in the closed reduction and pin fixation group (p < 0.01). At nine and twelve weeks, patients in the open reduction and internal fixation group continued to have lower scores (17 compared with 39 [p < 0.01] and 11 compared with 26 [p = 0.01], respectively). At one year, there was no significant difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand scores. Patients in the open reduction and internal fixation group had greater range of motion and strength than patients in the closed reduction and pin fixation group at six and nine weeks, and more patients in the open reduction and internal fixation group were very satisfied with the overall wrist function and motion. Eight complications occurred, two in the open reduction and internal fixation group and six in the closed reduction and pin fixation group.

Conclusions: Both closed reduction with percutaneous pin fixation and open reduction with internal fixation with use of a volar plate are effective methods for the treatment of dorsally displaced, unstable, extra-articular or simple intra-articular fractures of the distal part of the radius. Better functional results can be expected in the early postoperative period in association with open reduction and internal fixation, and this form of treatment should be considered for patients requiring a faster return to function after the injury.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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