VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years
Abstract Background Primary aim: to compare complications of operative vs non-operative treatment of unstable distal radius fractures (DRF) fulfilling national clinical guidelines for operative treatment. Secondary aim: to compare the functional outcomes. Materials and methods A single-centre random...
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| Format: | Article |
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SpringerOpen
2022-11-01
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| Series: | Journal of Orthopaedics and Traumatology |
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| Online Access: | https://doi.org/10.1186/s10195-022-00673-4 |
| _version_ | 1797985471218843648 |
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| author | Rikke Thorninger Daniel Wæver Michael Tjørnild Martin Lind Jan Duedal Rölfing |
| author_facet | Rikke Thorninger Daniel Wæver Michael Tjørnild Martin Lind Jan Duedal Rölfing |
| author_sort | Rikke Thorninger |
| collection | DOAJ |
| description | Abstract Background Primary aim: to compare complications of operative vs non-operative treatment of unstable distal radius fractures (DRF) fulfilling national clinical guidelines for operative treatment. Secondary aim: to compare the functional outcomes. Materials and methods A single-centre randomized controlled trial of unstable DRF. 50 patients: volar locking plate, 2 weeks casting + 3 weeks orthosis. 50 patients: 5 weeks casting. Primary outcome: complications assessed after 2 and 5 weeks and 6 and 12 months. Secondary outcomes: Quick-DASH, PRWHE, range of motion, grip strength, EQ-5D-3L. Results 148 patients were screened from November 2019 to March 2021. 48 patients did not want to participate or were unable to participate in the follow-up. 100 patients were randomized and 85 patients were available for full analysis due to there being 4 deaths, 6 withdrawals, 1 wrong inclusion, 1 emigration, 1 refracture, 1 patient with compartment syndrome, and 1 who was advised to undergo surgery after being randomized to non-operative treatment. Median age was 74 years (range 65–92), 81 women/19 men, 42 right/58 left side, 87 retired, 11 smokers, 86 ASA class 1 or 2. Complication rates did not statistical significantly vary between the operative and non-operative group: 20.9% (9/43) vs 16.6% (7/42), p = 0.78 (Fisher’s exact test). Complications were driven by sensory disturbances. Four reoperations were performed: two in the non-operative group: carpal tunnel syndrome; two in the operative group: one carpal tunnel syndrome, one protruding screw causing extensor tendon irritation. Mean difference in Quick-DASH varied from 2.3 (95% CI − 3 to 8) pre-injury to 4.2 (− 4 to 12) at 12 months. Quick-DASH and PRWHE were neither statistically nor clinically-relevant different between groups. Conclusions Complication rates after operative and non-operative treatment of DRF were similar. Volar plating did not improve the functional outcome after 5 weeks, 6 months, and 12 months. These findings are in line with recent RCTs and mandate a revision of guidelines towards more conservative treatment. Take home messages: (1) consider non-operative treatment in elderly patients sustaining unstable DRFs; (2) choosing operative treatment in patients older than 65 years should not be the gold standard; (3) however, non-operative treatment still carries a risk for complications. Level of evidence II. Trial registration Clinicaltrials.gov NCT03716661, registered 23rd Oct 2018; Published protocol PMC6599306. |
| first_indexed | 2024-04-11T07:18:41Z |
| format | Article |
| id | doaj.art-5796f62e785c4f38a08663dc72aff7dd |
| institution | Directory Open Access Journal |
| issn | 1590-9921 1590-9999 |
| language | English |
| last_indexed | 2024-04-11T07:18:41Z |
| publishDate | 2022-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj.art-5796f62e785c4f38a08663dc72aff7dd2022-12-22T04:37:50ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99211590-99992022-11-012311810.1186/s10195-022-00673-4VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 yearsRikke Thorninger0Daniel Wæver1Michael Tjørnild2Martin Lind3Jan Duedal Rölfing4Department of Orthopaedics, Regional Hospital RandersDepartment of Orthopaedics, Regional Hospital RandersDepartment of Orthopaedics, Regional Hospital RandersDepartment of Clinical Medicine, HEALTH, Aarhus UniversityDepartment of Clinical Medicine, HEALTH, Aarhus UniversityAbstract Background Primary aim: to compare complications of operative vs non-operative treatment of unstable distal radius fractures (DRF) fulfilling national clinical guidelines for operative treatment. Secondary aim: to compare the functional outcomes. Materials and methods A single-centre randomized controlled trial of unstable DRF. 50 patients: volar locking plate, 2 weeks casting + 3 weeks orthosis. 50 patients: 5 weeks casting. Primary outcome: complications assessed after 2 and 5 weeks and 6 and 12 months. Secondary outcomes: Quick-DASH, PRWHE, range of motion, grip strength, EQ-5D-3L. Results 148 patients were screened from November 2019 to March 2021. 48 patients did not want to participate or were unable to participate in the follow-up. 100 patients were randomized and 85 patients were available for full analysis due to there being 4 deaths, 6 withdrawals, 1 wrong inclusion, 1 emigration, 1 refracture, 1 patient with compartment syndrome, and 1 who was advised to undergo surgery after being randomized to non-operative treatment. Median age was 74 years (range 65–92), 81 women/19 men, 42 right/58 left side, 87 retired, 11 smokers, 86 ASA class 1 or 2. Complication rates did not statistical significantly vary between the operative and non-operative group: 20.9% (9/43) vs 16.6% (7/42), p = 0.78 (Fisher’s exact test). Complications were driven by sensory disturbances. Four reoperations were performed: two in the non-operative group: carpal tunnel syndrome; two in the operative group: one carpal tunnel syndrome, one protruding screw causing extensor tendon irritation. Mean difference in Quick-DASH varied from 2.3 (95% CI − 3 to 8) pre-injury to 4.2 (− 4 to 12) at 12 months. Quick-DASH and PRWHE were neither statistically nor clinically-relevant different between groups. Conclusions Complication rates after operative and non-operative treatment of DRF were similar. Volar plating did not improve the functional outcome after 5 weeks, 6 months, and 12 months. These findings are in line with recent RCTs and mandate a revision of guidelines towards more conservative treatment. Take home messages: (1) consider non-operative treatment in elderly patients sustaining unstable DRFs; (2) choosing operative treatment in patients older than 65 years should not be the gold standard; (3) however, non-operative treatment still carries a risk for complications. Level of evidence II. Trial registration Clinicaltrials.gov NCT03716661, registered 23rd Oct 2018; Published protocol PMC6599306.https://doi.org/10.1186/s10195-022-00673-4distal radius fractureconservative treatmentoperative treatmentcomplicationsfunctional outcome PROM |
| spellingShingle | Rikke Thorninger Daniel Wæver Michael Tjørnild Martin Lind Jan Duedal Rölfing VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years Journal of Orthopaedics and Traumatology distal radius fracture conservative treatment operative treatment complications functional outcome PROM |
| title | VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years |
| title_full | VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years |
| title_fullStr | VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years |
| title_full_unstemmed | VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years |
| title_short | VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years |
| title_sort | volcon a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years |
| topic | distal radius fracture conservative treatment operative treatment complications functional outcome PROM |
| url | https://doi.org/10.1186/s10195-022-00673-4 |
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