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

Are Volar Locking Plates a Cost Effective Strategy for the Treatment of Distal Radius Fractures in Patients <65 Years of Age?

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.

Study Overview

• Status: Unknown
• Conditions: Distal Radius Fracture
• Intervention / Treatment: Procedure: Surgical Repair of Distal Radius Fracture

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.

• Study Type: Interventional
• Enrollment (Anticipated): 64
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ruby Grewal, MD, FRCSC; Phone Number: 519-646-6286; Email: ruby.greal@sjhc.london.on.ca
• Study Contact Backup: Name: Chris A Young, B.A; Phone Number: 64875 519-646-6100; Email: chris.young@sjhc.london.on.ca

Study Locations

• Canada
  • Ontario
    • London, Ontario, Canada, N6A4L6
      • Hand and Upper Limb Clinic, St Joseph's Health Care
      • Contact: James H Roth, MD, FRCSC, FACS; Phone Number: 519-646-6050; Email: james.roth@sjhc.london.on.ca
      • Contact: Joy C MacDermid, MScPT, PhD; Phone Number: 64636 519-646-6100; Email: joy.macdermid@sjhc.london.on.ca
      • Principal Investigator: Ruby Grewal, MD, FRCSC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 64 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: closed reduction with percutaneous k-wire fixation and casted	Procedure: Surgical Repair of Distal Radius Fracture; 2 surgical methods to treat Distal Radius Fracture
Active Comparator: open reduction internal fixation with a volar locked plate	Procedure: Surgical Repair of Distal Radius Fracture; 2 surgical methods to treat Distal Radius Fracture

What is the study measuring?

Primary Outcome Measures

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

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective measures	ROM, Strength and Dexterity will be assessed	3, 6, and 12 months following surgery

Collaborators and Investigators

• Sponsor: Hand and Upper Limb Clinic, Canada
• Collaborators: Canadian Orthopaedic Foundation
• Investigators: Principal Investigator: Ruby Grewal, MD, FRCSC, Hand and Upper Limb Clinic, St. Joseph's Health Care

Publications and helpful links

Helpful Links

• Hand and Upper Limb Centre Website

Study record dates

Study Major Dates

• Study Start: April 1, 2011
• Primary Completion (Anticipated): March 1, 2014
• Study Completion (Anticipated): March 1, 2014

Study Registration Dates

• First Submitted: April 8, 2011
• First Submitted That Met QC Criteria: April 11, 2011
• First Posted (Estimate): April 12, 2011

Study Record Updates

• Last Update Posted (Estimate): April 12, 2011
• Last Update Submitted That Met QC Criteria: April 11, 2011
• Last Verified: April 1, 2011

More Information

Terms related to this study

• Keywords: Distal Radius; Volar locked plating; Cost Effectiveness; Randomization; Outcomes
• Additional Relevant MeSH Terms: Wounds and Injuries; Arm Injuries; Forearm Injuries; Fractures, Bone; Radius Fractures
• Other Study ID Numbers: HULC drf-Volar Plate; 17545 (Canadian Orthopedic Foundation Department of Surgery Internal Research Fund)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No