Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial
Abstract Background This study aimed to compare functional outcomes of a volar plate osteosynthesis for distal radius fractures (DRF) performed with either a standard volar approach (SVA), which required detachment of the pronator quadratus muscle, or a pronator-sparing approach (PqSA). Materials an...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-04-01
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| Series: | Journal of Orthopaedics and Traumatology |
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| Online Access: | https://doi.org/10.1186/s10195-023-00700-y |
| _version_ | 1797836333741244416 |
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| author | Gerhild Thalhammer Laura A. Hruby Theresia Dangl Jonas Liebe Jochen Erhart Thomas Haider |
| author_facet | Gerhild Thalhammer Laura A. Hruby Theresia Dangl Jonas Liebe Jochen Erhart Thomas Haider |
| author_sort | Gerhild Thalhammer |
| collection | DOAJ |
| description | Abstract Background This study aimed to compare functional outcomes of a volar plate osteosynthesis for distal radius fractures (DRF) performed with either a standard volar approach (SVA), which required detachment of the pronator quadratus muscle, or a pronator-sparing approach (PqSA). Materials and methods This prospective randomized controlled study included 106 patients scheduled for volar plate osteosyntheses. Patients were allocated to either the SVA group (n = 53) or the PqSA group (n = 53). Patients were blinded to treatment until completion of the study. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcome parameters were the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Modified Mayo Wrist Score (MMWS). Follow-up examinations were performed at 8 weeks and 3, 6, and 12 months postoperatively. Results Overall, 91 patients were included in the final analysis: 48 in the SVA group and 43 in the PqSA group. The two cohorts were not significantly different in demographic characteristics, including age, sex, injuries on the dominant side, type of injury, and fracture classification. We found significant differences between groups at 6 months in the mean PRWE (SVA: 12.3 ± 10.4, PqSA: 18.9 ± 14.11 points) and in the mean DASH score (SVA: 12.3 ± 11.9, PqSA: 19.3 ± 16.7 points), which favoured the SVA. We found no significant differences between groups in the MMWS or in the PRWE and DASH scores at any other time points. Conclusions This randomized comparative clinical trial failed to demonstrate that a volar plate osteosynthesis performed with a PqSA could improve the outcome, compared to the SVA, in patients with DRF. Level of evidence II Trial registration Comparison of Two Volar Plating Systems for Distal Radius Fractures, ClinicalTrials.gov (NCT03474445), registered 22 March 2018, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03474445?cond=radius&cntry=AT&draw=2&rank=1 |
| first_indexed | 2024-04-09T15:07:08Z |
| format | Article |
| id | doaj.art-28f1d6b0d37c4eb185ae4a57e4bda568 |
| institution | Directory Open Access Journal |
| issn | 1590-9999 |
| language | English |
| last_indexed | 2024-04-09T15:07:08Z |
| publishDate | 2023-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj.art-28f1d6b0d37c4eb185ae4a57e4bda5682023-04-30T11:23:56ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992023-04-012411810.1186/s10195-023-00700-yDoes the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trialGerhild Thalhammer0Laura A. Hruby1Theresia Dangl2Jonas Liebe3Jochen Erhart4Thomas Haider5Department of Orthopedics and Trauma Surgery, Medical University of ViennaDepartment of Orthopedics and Trauma Surgery, Medical University of ViennaDepartment of Orthopedics and Trauma Surgery, Medical University of ViennaDepartment of Orthopedics and Trauma Surgery, Medical University of ViennaDepartment of Orthopedics and Traumatology, Hospital of the St. John of God Brothers EisenstadtDepartment of Orthopedics and Trauma Surgery, Medical University of ViennaAbstract Background This study aimed to compare functional outcomes of a volar plate osteosynthesis for distal radius fractures (DRF) performed with either a standard volar approach (SVA), which required detachment of the pronator quadratus muscle, or a pronator-sparing approach (PqSA). Materials and methods This prospective randomized controlled study included 106 patients scheduled for volar plate osteosyntheses. Patients were allocated to either the SVA group (n = 53) or the PqSA group (n = 53). Patients were blinded to treatment until completion of the study. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcome parameters were the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Modified Mayo Wrist Score (MMWS). Follow-up examinations were performed at 8 weeks and 3, 6, and 12 months postoperatively. Results Overall, 91 patients were included in the final analysis: 48 in the SVA group and 43 in the PqSA group. The two cohorts were not significantly different in demographic characteristics, including age, sex, injuries on the dominant side, type of injury, and fracture classification. We found significant differences between groups at 6 months in the mean PRWE (SVA: 12.3 ± 10.4, PqSA: 18.9 ± 14.11 points) and in the mean DASH score (SVA: 12.3 ± 11.9, PqSA: 19.3 ± 16.7 points), which favoured the SVA. We found no significant differences between groups in the MMWS or in the PRWE and DASH scores at any other time points. Conclusions This randomized comparative clinical trial failed to demonstrate that a volar plate osteosynthesis performed with a PqSA could improve the outcome, compared to the SVA, in patients with DRF. Level of evidence II Trial registration Comparison of Two Volar Plating Systems for Distal Radius Fractures, ClinicalTrials.gov (NCT03474445), registered 22 March 2018, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03474445?cond=radius&cntry=AT&draw=2&rank=1https://doi.org/10.1186/s10195-023-00700-yDistal radius fractureVolar platingOsteosynthesisDistal radiusPronator quadratus |
| spellingShingle | Gerhild Thalhammer Laura A. Hruby Theresia Dangl Jonas Liebe Jochen Erhart Thomas Haider Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial Journal of Orthopaedics and Traumatology Distal radius fracture Volar plating Osteosynthesis Distal radius Pronator quadratus |
| title | Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial |
| title_full | Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial |
| title_fullStr | Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial |
| title_full_unstemmed | Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial |
| title_short | Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial |
| title_sort | does the pronator sparing approach improve functional outcome compared to a standard volar approach in volar plating of distal radius fractures a prospective randomized controlled trial |
| topic | Distal radius fracture Volar plating Osteosynthesis Distal radius Pronator quadratus |
| url | https://doi.org/10.1186/s10195-023-00700-y |
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