CROSSFIRE

Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial

Combined Randomised and Observational Study of Surgery for Fractures in the Distal Radius in the Elderly (CROSSFIRE) Study Group, Lawson A, Naylor JM, et al. JAMA surgery 2021 · PMID 33439250 · doi:10.1001/jamasurg.2020.5672

Question

In adults aged 60 and over with displaced distal radius fractures, is volar plating superior to closed reduction and casting?

Design

Multicentre RCT with a parallel observational cohort across 19 centres in Australia and New Zealand, with blinded outcome assessment.

Patients

Adults aged 60 years and over with a displaced distal radius fracture.

Intervention

Volar locking plate fixation

Comparison

Closed reduction and cast immobilisation

Primary outcome

Patient-Rated Wrist Evaluation (PRWE) at 12 months

Key result

There was no clinically important difference in PRWE at 12 months between plating and casting, and no clinically important differences in quality of life.

Limitations

Patients and surgeons were not blinded, and many eligible patients declined randomisation, which may limit generalisability.

Impact on practice

Adds to the evidence that most older adults with displaced distal radius fractures can be treated in a cast without loss of function.