Study finds plating distal radius fractures effective but costly

Open plating also required more OR time vs. closed percutaneous pinning, adding to costs.

Issue: December 2005

In the world of hand surgery, new surgical techniques and implants promising to provide reliable solutions for treating distal radius fractures come and go. To test one such operative approach, a relatively new wrist fixation system, a team of hand surgeons retrospectively studied its results and compared them to those with closed percutaneous pinning.

“We found the two treatment methods resulted in similar clinical and radiographical outcomes at 14 months follow-up,” said Louis W. Catalano III, MD, who presented results at the Joint Annual American Society for Surgery of the Hand/American Society for Hand Therapists Meeting.

But because the open reduction internal fixation (ORIF) plating system cost about $4000 more than pinning the fractures with K-wires, and required 54 more minutes of OR time, surgeons may need to think twice about grabbing that plating system next time they operate on a patient’s distal radius fracture.

The operative time in the pinning group (CRPP) was significantly less, 36 minutes vs. 90 minutes (P=.03).

However, one possible advantage associated with the plating technique: Patients could start moving their wrists 25 days postoperatively compared to 40 days for the CRPP group (P<.00001).

Similarity of patients treated for distal radius fractures with two methods, and their outcomes, evident in data summary
Parameter	CRPP	ORIF	P Value
N	22	21
Age at injury	63	59	0.52
Flexion/Extension Arc	149°	138°	0.43
Grip strength (% of injured side)	78%	88%	0.1
Visual Analog Scale	1.7	2.7	0.3
DASH score	17	22	.034
Patient satisfaction	93.4%	89.2%	0.10

“The benefits of earlier postoperative motion in the ORIF group are unclear, as range of motion did not differ significantly between the two groups at follow-up,” said Catalano, who conducted the study with his colleagues at the C.V. Starr Hand Surgery Center in New York.

From a database, surgeons selected 43 patients operated on over a four-year period who had 14 months of follow-up, average. At the time, the ORIF plates used, manufactured by TriMed Inc., Valencia, Calif., represented the newest technology, Catalano told Orthopedics Today.

The CRPP group consisted of 22 patients whose distal radius fractures were treated with closed reduction percutaneous pinning and the ORIF group consisted of 21 patients treated with the TriMed plates. Investigators excluded AO type B fractures, any high-energy injuries, patients with concurrent upper extremity fractures and cases when surgery occurred more than 21 days postinjury.

There were seven AO type A and 15 AO type C in the CRPP group. In the ORIF group there were five AO type A and 16 AO type C fractures. The fracture types and demographics across the two groups facilitated good patient matching, Catalano said.

Outcomes significantly similar

Outcome measurements the investigators used included range of motion, grip strength, Disabilities of the Arm, Should and Hand (DASH) scores, Visual Analog Scale (VAS) pain scores and patient satisfaction. They found no significant differences in these measures with regard to hand motion, grip strength, pain and deformity in either group.

“We found no significant differences in volar tilt, radial inclination, ulnar variance or degenerative changes,” Catalano said. They identified two cases of stepping out deformities less than 2 mm in the CRPP group; four in the ORIF group.

Perhaps another reason to avoid plating: 50% of ORIF patients required reoperations, mostly for symptomatic hardware.

Catalano said he will stick to pinning these wrist fractures and awaits results of his group’s next study, which is expected to follow patients treated with the latest technique: volar plating.

For more information:

Brooks JJ, Glickel SZ, Barron OA, Catalano LW. Operative treatment of fractures of the distal radius: A comparison of two methods. #PAS19. Presented at the Joint Annual ASSH/ASHT Meeting. Sept. 22-24, 2005. San Antonio.