Arora volar plate vs cast (65+)

A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older

Arora R, Lutz M, Deml C, et al. The Journal of bone and joint surgery. American volume 2011 · PMID 22159849 · doi:10.2106/jbjs.j.01597

Question

In patients aged 65 and over with displaced unstable distal radius fractures, does volar plating improve function compared with closed reduction and casting?

Design

Single-centre prospective RCT in Austria.

Patients

Patients aged 65 years or older with displaced, unstable distal radius fractures.

Intervention

Open reduction and volar locking plate fixation

Comparison

Closed reduction and cast immobilisation

Primary outcome

PRWE, DASH, pain and range of motion over 12 months

Key result

Plating gave better early PRWE and DASH scores and better grip strength throughout, but by 12 months there was no significant difference in range of motion, pain, PRWE or DASH; anatomical reconstruction did not translate into better motion or daily function.

Limitations

Small single-centre trial with limited power for secondary outcomes.

Impact on practice

Established that radiographic malunion is often well tolerated in older patients, supporting non-operative treatment for many low-demand older adults.