Minimax study; open reduction and internal fixation with volar fixed-angle plating vs percutaneous reduction and external fixation for displaced intra-articular fractures of the distal radius in the eldery

Fractures of the distal radius are a common clinical problem, frequently seen on the emergency department. Almost 60 % of all distal radius fractures represents intra-articular fractures. Because displaced intra-articular fractures of the distal radius are considered to be unstable, operative treatment is necessary for acceptable functional outcome after union. There is no consensus of best operative treatment of these fracture types. The traditional approach to treating intra-articular distal radius fractures has been external fixation.
In recent years, the use of volar, locked plates has gained popularity as a treatment option in the management of these fractures. This study aims to demonstrate a clinically significant difference using the Disability of Arm, Shoulder and Hand (DASH) score after one year. Open reduction and internal fixation using volar fixed-angle locking plates and percutaneous reduction and fixation with external fixation will be compared in an adequately powered, multicenter randomized controlled trial with 2 treatment arms. Clinical outcome will be measured using the DASH-score, the Mayo Wrist score, standard physical exam and radiographic criteria after 6 weeks, 3 months, six months and one year.

ORIF with volar fixed-angle plates and external fixation have a similar outcome as measured with the DASH score (and the Mayor Wrist Score).

Post-operative controll-moments:

after 1 week, 6 weeks, 3 months, 6 months and one year

This study will randomise between:

1. Open reduction and internal fixation via a volar approach using volar fixed-angle locking plates and

2. Closed reduction, percutaneous pinnen and fixation, and external fixation with additional adjuncts.