Assessing Volar Locking Plates in Patients Under 65 With a Distal Radius Fracture

Overview

Patients will be randomized to volar plating with early ROM versus closed reduction with K-wires and 6 weeks of cast immobilization to determine if there is any advantage to volar plating in this subgroup of patients with distal radius fractures.

Full Title of Study: “Are Volar Locking Plates a Cost Effective Strategy for the Treatment of Distal Radius Fractures in Patients <65 Years of Age?”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: March 2014

Detailed Description

This study has been designed as a prospective randomized controlled trial examining the cost effectiveness of treating distal radius fractures with open reduction and internal fixation with a volar locking plate (VLP) to closed reduction and k-wire fixation (K-Wires). All patients aged < 65 years with an isolated distal radius fracture (extra-articular or simple intra-articular, AO type A or C1) requiring operative fixation will be included in this study. Patients who have underlying osteoporosis, other injuries or complex intra-articular fractures will be excluded from this study. Once eligibility is determined, patients will be randomized to one of two treatment arms. They will be treated with either a closed reduction with percutaneous k-wire fixation and 6 weeks of cast immobilization (K-wire) or open reduction internal fixation with a volar locked plate and early range of motion (beginning at 10-14 days) (VLP). All patients will undergo a standardized pre-operative evaluation. This will include classification of their fracture (based on the AO classification), a baseline PRWE and DASH score, a measure of their general health (SF-12) and a general health utility questionnaire (EQ-5d). Patients will be required to report the details of their occupational physical demands and the number of work days missed due to injury. Patient testing will be incorporated into scheduled clinic visits. Data will be collected at the initial assessment, 2 weeks post-operatively, and then at 6 weeks, 12 weeks, 6 months and 12 months after the fracture. At each visit, AP and lateral wrist radiographs will also be obtained. The investigators will then examine the outcomes of each group based on range of motion, grip strength, and standardized patient rated pain and disability scores (PRWE and DASH). In order to capture differences between the 2 groups in the early phases of recovery - the investigators will administer 2 additional assessments at 4 and 9 weeks by either phone or email. These telephone assessments will include an assessment of patient rated pain and disability (DASH, PRWE) and patients will be asked to provide details on whether they have returned to work or their usual activities. The primary outcome, patient rated pain and disability, will be quantified with the Patient Rated Wrist Evaluation (PRWE) a tool which has been shown to be valid, reliable and highly responsive in the distal radius fracture population. Secondary outcomes will include range of motion, strength, Disabilities of Arm Shoulder and Hand Score (DASH) and time to return to work. The cost analysis will include both direct and indirect costs, and will include: OR time, anesthesia time, surgeon fees, cost of outpatient visits, equipment costs (volar locked plates and k-wires), x-rays, casting, splints, number of work days missed and work disability costs. The investigators will also use the health utility score (EQ-5d) to determine the cost per quality adjusted life year (QALY) associated with each intervention. Based on our sample size calculations, the investigators will need 28 patients in each treatment arm (power 80%, p = 0.05). Allowing for a 10-15% drop-out rate, 64 patients are required for enrollment. The secondary outcomes will include ROM, grip strength, union rate, mean time to union (weeks) and DASH score.

Interventions

  • Procedure: Surgical Repair of Distal Radius Fracture
    • 2 surgical methods to treat Distal Radius Fracture

Arms, Groups and Cohorts

  • Active Comparator: closed reduction with percutaneous k-wire fixation and casted
  • Active Comparator: open reduction internal fixation with a volar locked plate

Clinical Trial Outcome Measures

Primary Measures

  • Patient Rated Wrist Evaluation
    • Time Frame: Prior to randomization and at 3, 6, and 12 months following randomization
    • Questionnaire administered to assess subjective levels of pain and function

Secondary Measures

  • Objective measures
    • Time Frame: 3, 6, and 12 months following surgery
    • ROM, Strength and Dexterity will be assessed

Participating in This Clinical Trial

Inclusion Criteria

  • Distal radius fracture – AO type A or C1 – Skeletally mature – Age 18-65 years old – Isolated injury Exclusion Criteria:

  • AO Type B or C2,3 – Other injuries involving affected or unaffected arm – Skeletally immature

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 64 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Hand and Upper Limb Clinic, Canada
  • Collaborator
    • Canadian Orthopaedic Foundation
  • Provider of Information About this Clinical Study
    • Dr. Ruby Grewal, Hand and Upper limb Clinic
  • Overall Official(s)
    • Ruby Grewal, MD, FRCSC, Principal Investigator, Hand and Upper Limb Clinic, St. Joseph’s Health Care
  • Overall Contact(s)
    • Ruby Grewal, MD, FRCSC, 519-646-6286, ruby.greal@sjhc.london.on.ca

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.