Artikel
Stainless steel versus titanium volar multi-axial locking plates for fixation of distal radius fractures: a randomised trial
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Autoren
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Greg Couzens
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Justin Alexander
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Paul Hak
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Samantha Rayner
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Steve Frederiksen
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Susan E. Peters
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Louise Lee
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Jeremy Loveridge
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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James S. Logan
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Titanium and stainless steel volar plating systems for distal radius fractures are both in common use in orthopaedic surgery. Titanium implants have been reported to have benefits including reduced implant stiffness, increased biocompatibility and diminished stress shielding compared to stainless steel implants, however tenosynovitis and extensor tendon ruptures have been reported in the use of titanium plates and may be less common with stainless steel implants.
This study aimed to determine the clinical outcomes and effectiveness of the two devices used to manage distal radius fractures.
Methods: This is a double blinded, randomised controlled trial with outpatient data collection investigating the effectiveness of the two interventions. Pain and satisfaction in a visual analogue scale (VAS), function measured with the PRWHE and QuickDASH, wrist range of motion and grip strength were measured. As expected from a randomised allocation study, no baseline differences were found between groups in demographic or outcome measures. Preliminary data are reported as median (25% - 75%) values.
Results and Conclusions: Data has been collected from 46 stainless steel and 49 titanium-plated forearms, 32 and 27 of which have had at least one assessment equal or greater to 3 months after surgery. Analysis at 3 months showed VAS pain and satisfaction to be 15.0 (7.25 - 45.75) and 78.5 (49.5 - 92.3) respectively for stainless steel participants and 15.2 (2.0 - 28.0) and 80.0 (45.25 - 96.0) respectively for titanium participants. At three months, PRWHE measured 26.0 (10.0 - 40.5) for the stainless steel group and 15.0 (5.50- 43.5) for the titanium group, whereas QuickDASH scores were 15.9 (9.1 - 34.1) for the stainless steel group and 20 (2.3 - 40.9) for the titanium group. Measures of wrist range of motion were similar between the two groups at 3 months. Grip strength was 19.3 kg (14.3 - 22.0) and 17.0 (11.3 - 24.0) respectively. Three revisions per group were recorded at most recent follow-up (stainless steel 7 months (range 4 - 40) and titanium 5 months (range 0 - 33)). No differences were found to be statistically significant.
These results suggest that the plates are comparable in terms of their functional, clinical, and radiological outcomes, and that the revision rates do not differ. The outcomes of this study should allow surgeons to make a more informed choice between stainless steel and titanium volar locking plates when fixing distal radius fractures.
