Fixation Of the Radius: Radiological and Clinical Evaluation
Research type
Research Study
Full title
A Prospective randomized trial of volar plate fixation versus cast management for fractures of the distal radius in the elderly.
IRAS ID
196519
Contact name
Samuel G Molyneux
Contact email
Sponsor organisation
NHS Lothian Research & Development Office
Duration of Study in the UK
3 years, 2 months, 0 days
Research summary
The radius is the main weight bearing bone of the forearm. The end of this bone (called the 'distal radius - i.e. the bit furthest away from the body) articulates with the small bones of the wrist and is easily broken during falls in which the patient puts their hand out to protect themselves. In fact, these distal radius fractures are the commonest fracture encountered in clinical practice, accounting for 16% of all fractures. Despite this the evidence regarding the optimal treatment of these injuries is contradictory. In fractures with no change in the position of the bones it is generally and widely agreed that management with a simple cast is optimal. There is, however, a marked paucity of prospective literature directly comparing non-operative with operative intervention in displaced distal radius fractures (i.e. the bone parts have moved out of position) . The retrospective studies available show no convincing evidence that operative intervention correlates with improved patient reported outcomes and satisfaction in the elderly population. Despite this treatment of these injuries with a locked volar plate is currently considered the gold standard. This surgery consists of an incision over the palmar side of the wrist, reducing the bone into a good position under direct vision and then holding it there using a metal plate and some specialist screws. While this makes for better x-rays its effect on function in elderly patients is unclear.
Our trial will include all patients over 65 presenting to the Edinburgh Orthopaedic Trauma Unit with a fracture of the distal radius that would normally require operative fixation. Patients who consent to enrol in the trial will be randomised to operative fixation using a volar plate or to non-operative management in a plaster cast. Patients will be evaluated over a two year period following
their surgery.REC name
South East Scotland REC 01
REC reference
16/SS/0024
Date of REC Opinion
17 Mar 2016
REC opinion
Further Information Favourable Opinion