Surgical versus conservative management of distal radius fracture with coronal shift; a randomized controlled trial

Abstract

Background: Coronal shift is one of the most critical complications related to distal radius fracture (DRF), leading to instability in the distal radioulnar joint (DRUJ). Nevertheless, there is no unified approach for the managing DRF with coronal shift; therefore, the current study aims to compare the surgical versus conservative approach for the coronal shift due to DRF treatment. Methods: This is a randomized clinical trial conducted on 50 patients with distal radius fracture (type 1 based on Fernandez Classification of Distal Radius Fractures) with a coronal shift in 2014-17. The patients were randomly allocated to treatment conservatively (n=25) by a long arm casting or surgically (n=25) using a volar plate fixation. The patients were followed for 24 months, and primary outcomes included a functional score on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; pain score based on the Visual Analogue Scale (VAS), and handgrip strength (HGS) measured via a dynamometer were assessed and compared. Results: Both approaches led to significant improvement in range of motion, pain complaint, DASH scores, and HGS at the end of the two-year follow-up (P-value <0.05). The comparison of the trend of changes in the two groups generally revealed a remarkable better range of motions, VAS, and HGS among the operated cases (P-value 0.05); however, DASH score did not differ (P-value 0.05). Conclusion: The long-term outcomes of volar plate fixation for DRF management (bending fracture of metaphysis) plus coronal shift are notably superior to the conservative treatment; however, due to the limited information in this regard, further evaluations are strongly recommended.