TREATMENT OF DISTAL RADIUS FRACTURES DUE TO HIGH-ENERGY INJURIES: A PROSPECTIVE RANDOMISED COMPARATIVE STUDY

Abstract

Objective: The purpose of this study was to compare the functional and workers compensation results of displaced intra-articular distal radius fractures treated with three diferent type of treatments.

Material and Methods: A randomized prospective study to evaluate 70 patients with displaced intraarticular distal radius fractures. The mean age were 40 years (range, 22–65 years) and all patients were medium or high level workers (40% dominant-hand). Three randomized groups were treated: 19 patients with close reduction and a cast (group 1); 24 patients with close reduction, percutaneous fixation with Kw and a cast (group 2); and 27 patiens with close reduction and external fixation and Kw (group 3).

Postoperative complications, pain (visual analogue scale), clinical and functional outcome based on DASH score, grip strength, X-ray evaluation, time to return to work and activity level were evaluated and compared at 3, 6 and 12 months of prospective follow-up.

Results: Consolidation was obtained in all cases at 7 weeks. Results at 12 months of follow-up: Pain evaluation score: 2.3 (group 1), 2.9 (group 2) and 1.5 (group 3); mean lost of ROM was 11° (group 1), 11° (group 2) and 23.9° (group 3); mean DASH score was 7 (group 1), 29 (group 2) and 12 (group 3). Average lost of pinch strength was 18.3% (group 1), 23% (group 2) and 35% (group 3). Non-aceptable X-ray parameters: 65% (group 1), 35% (group 2) and 50% (group 3).

Re-operations: 10% (group 1), 7.6% (group 2) and 14.8% (group 3). The average time to return to work (weeks) was 12 (group 1), 14 (group 2) and 19.3 (group 3). All patients return to the work and activity level they had before injury.

Conclusions: Similar results were obtained in the three groups at 12 months but better clinical results for the conservative group (group 1) at 3 and 6 months of FU. The orthopaedic treatment achieved better functional results with lesser lost of ROM, time out of work, more grip strength and better DASH score. Percutaneous fixation achieve better X-ray results at the end of FU with lesser re-operations. The functional and clinical outcomes after one year still are unknown. Hence, more and longer studies are required to confirm these results.