Outcome and New Methods of Surgical Treatment

Stable distal radius fractures are treated non-surgically in a cast. Unstable distal radius fractures are treated with surgery. The majority of patients have good outcome, but up to one fifth are not satisfied. In this thesis the overall aim was to compare newer surgical techniques, evaluate our treatment over a longer time-period, and identify risk factors for poor outcome. In a previous randomized study of unstable distal radius fractures, better grip strength and pronation-supination were found at one year in patients treated with open reduction and fragment-specific fixation compared to closed reduction and external fixation. In a follow up at five years, both grip strength as well as pronation-supination had normalized in both groups and no clinical or radiographic differences were found. In a new randomized trial of unstable distal radius fractures, comparing the fragment-specific fixation and the newer volar locking plate, no difference was found in the primary outcome grip strength at one year. Both the fragment-specific fixation and the volar locking plate achieved good subjective, objective and radiological outcome, with more complications in the fragment-specific group. In a prospective and consecutive distal radius fracture registry, a retrospective decade-long study analyzed the subjective outcome at one year, using the Disabilities of Arm Shoulder and Hand (DASH) questionnaire. At one year, good outcome was found for both non-surgically and surgically treated patients, but despite a shift of implant over the 10-year period, with volar locking plates replacing the external fixators and fragment-specific fixation, no change was found in subjective outcome. Finally, patients with major disability at one year, identified in the distal radius fracture registry, were re-evaluated at 2 12 years. Half of the patients improved, but only a small proportion returned to normal scores and the rest improved to a moderate level of disability. In conclusion, the surgical methods to treat distal radius fractures are good. But, a limited proportion of both and surgically treated patients has an inferior outcome. In the future, we need to focus on this subgroup and find better ways to identify causes to inferior outcome and try to prevent these complications before they become irreversible.