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Distal Radius FracturesDRFNCT00524719

Comparison of Three Fixation Techniques for Displaced Distal Radius Fractures

A study testing Open Reduction and Internal Fixation, Non-Spanning External Fixation and Closed Reduction with Percutaneous Fixation in people with Distal Radius Fractures, run by McGill University Health Centre/Research Institute of the McGill University Health Centre at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Distal radius fractures are the most common fracture to occur in the adult population, and those which are displaced but maintain joint congruity are the most common subtype. Locking-plate technology represents a true advance in the fixation of these fractures, especially in view of the ever increasing incidence of… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Distal Radius Fractures
What is being tested?
Open Reduction and Internal Fixation, Non-Spanning External Fixation and Closed Reduction with Percutaneous Fixation
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
203 participants
Where
1 siteCanada
Study dates
Jan 2007to 3 Apr 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Patient Inclusion Criteria:

  1. Over 18 years of age with skeletal maturity, and consenting to participate.
  2. A displaced distal metaphyseal radius fracture (AO type A2, A3, C1, C2--- appendix 1) with a congruous joint surface (< 2 mm displacement) either before or after closed reduction.
  3. 21 days or less between injury and surgery.
  4. The patient must be medically fit for anaesthesia.
  5. The patient must have the mental faculties to participate in post- operative evaluation.

Patient exclusion criteria:

  1. Significant bone disorder (osteomalacia, hyperparathyroidism) which may impair bone healing (not including osteoporosis).
  2. Open fracture.
  3. Neurovascular injury requiring repair in same limb.
  4. Ipsilateral limb injury.
  5. Active infection in area of surgical approaches.
  6. Prior wrist injury or degenerative condition, or congenital wrist anomaly.

Fracture inclusion criteria:

Patients sustaining a displaced AO type A2 A3 C1 or C2 distal metaphyseal radius fracture with preserved joint congruity before (52) or after closed reduction are eligible for inclusion. Radiographic criteria for an unacceptable closed reduction include:

  1. Palmar tilt < 00.
  2. Radial inclination < 150.
  3. Radial shortening > 5 mm.
  4. Articular step or gap > or= 2 mm.

Fracture exclusion criteria:

  1. Fractures with apex dorsal angulation ("Smith fracture") will be excluded as they are not amenable to treatment with all three methods.
  2. Less than 1 cm of intact volar cortex on the distal fragment as this is the minimum necessary for non-spanning external fixation (40, 48).

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • McGill University Health Centre - Montreal General Hospital

    Montreal, Quebec, H3G 1A4

Other trials in Canada

About this study

Official title: A Prospective Randomised Trial Comparing Open Reduction and Internal Fixation, Non-Spanning External Fixation, and Closed Reduction With Percutaneous Fixation in Displaced Distal Radius Fractures With Joint Congruity

Distal radius fractures are the most common fracture to occur in the adult population, and those which are displaced but maintain joint congruity are the most common subtype. Locking-plate technology represents a true advance in the fixation of these fractures, especially in view of the ever increasing incidence of these injuries in an ageing and osteoporotic population throughout Europe and North America. These plates permit rigid fixation, even in osteopenic bone, while avoiding any tethering of soft tissues, as seen with external fixation and percutaneous pinning. For these reasons, this mode of fracture fixation has rapidly gained popularity. Unfortunately, there is presently little evidence to support their use over the more traditional methods of fixation (percutaneous pinning, external fixation). In addition, the technique for their application is more invasive and their cost is considerably greater than these latter two techniques. As such, it is pertinent to evaluate, in a scientifically sound fashion, the outcome of fixation with the three types of implant included in this study. The results of this clinical trial will allow the orthopaedic community to confidently recommend the fixation method which provides the optimal functional, clinical, and radiographic outcome for a patient suffering a displaced distal radius with preserved joint congruity.

Null hypothesis: There is no difference in the functional, clinical, and radiographic outcomes of the three treatment methods.

Hypothesis: Given the locking nature of modern screw-plate constructs, which produce excellent fixation even in osteopenic bone and permit early range of motion exercises; and given that plate fixation, in contrast to external fixation and percutaneous pinning, does not tether muscle, tendon, or capsule; plate fixation with a volar fixed-angle device should permit earlier and more aggressive rehabilitation and more rapid and complete regain of hand and wrist function when compared to stabilization with external fixation or percutaneous pinning.

Read the detailed description

Fractures of the distal radius, the most common fracture to occur in adults, are increasing in incidence and cost due to ageing of the population and the link with senile osteoporosis. Young adults also suffer these injuries albeit involving higher-energy mechanisms. Closed reduction and casting is often unsuccessful in maintaining adequate alignment and length, both of which are crucial to a successful outcome. Thus, there has been a trend toward surgical treatment of these fractures. In fractures with preserved joint congruity, 3 fixation options exist: percutaneous pinning (Kapandji technique), non-spanning external fixation, and locked-plates. Locked-plates represent a significant advance in the fixation of fractures, especially in osteopenic bone, although their role in distal radius fractures has yet to be defined adequately. The Cochrane Group undertook a meta-analysis of RC trials "to determine when, and if so what type of, surgical intervention is the most appropriate treatment for fractures of the distal radius in adults." The authors concluded: "there is a need for good quality evidence for the surgical management of these fractures." The aim of this randomized clinical trial is to compare the functional, clinical, and radiographic outcomes of these 3 methods. The results will clearly guide surgeons in the choice of optimal technique.

This multicenter prospective randomized trial will involve the Canadian Orthopaedic Trauma Society (COTS), an association of trauma surgeons involved in collaborative outcomes research with a proven track record of research and publication. Patients with a displaced distal radius fracture with joint congruity who meet all eligibility criteria and provide consent to participate will be randomly assigned to reduction and fixation with one of three methods: volar locked-plate, percutaneous pinning and cast (Kapandji intra-focal technique), or non-spanning external fixation. Patients will undergo physiotherapy according to protocols adapted to fixation technique. Evaluation at fixed intervals will include functional, clinical, and radiological parameters. Functional evaluation will include the PRWE, DASH, and SMFA questionnaires. Clinical outcome will evaluate range of motion, pinch and grip strength, and dexterity. Standard radiographic parameters will be measured. The primary outcome measure will be functional outcome as measured with the PRWE. Appropriate statistical analyses will be performed on the data. Sample size calculation reveals the need for 108 patients per treatment arm. A census of the centers committed to the study predicts a 12-18 month recruitment period. Patient follow-up will end at 2 years.

Being tested
Open Reduction and Internal Fixation, Non-Spanning External Fixation, Closed Reduction with Percutaneous Fixation
Medical subject headings
Wrist Fractures

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Open Reduction and Internal FixationProcedure or surgery

    Fixation with volar locked plate

  • Non-Spanning External FixationProcedure or surgery

    Radio-radial external fixation

  • Closed Reduction with Percutaneous FixationProcedure or surgery

    Percutaneous intrafocal pinning (Kapandji technique)

Study groups in NCT00524719
Study groupRoleWhat they receive
Open, internal fixation volar plateActive comparatorOpen reduction and internal fixation (ORIF) with volar locked plate
Receives: Procedure: Open Reduction and Internal Fixation
Closed reduction with external fixatorActive comparatorSurgical procedure - Closed reduction and non-spanning external fixation (Ex-FIX)
Receives: Procedure: Non-Spanning External Fixation
Closed reduction percutaneous pinningActive comparatorSurgical procedure - Closed reduction with percutaneous pinning (CRPP) and the application of a cast
Receives: Procedure: Closed Reduction with Percutaneous Fixation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Primary Outcome Variable: Validated functional outcome tools to be used: patient rated wrist evaluation (PRWE) disability shoulder, arm, hand (DASH) short musculoskeletal functional assessment (SMFA)

    Measured: 6 weeks; 3,6,12 and 24 months

Secondary outcomes (1)
  1. Secondary Outcome Measures: Clinical outcome: measurement of range of motion (ROM), strength (grip and pinch), and dexterity (Jebsen hand function-checkers sub-test). Radiologic outcome: X-ray parameters

    Measured: 6 weeks; 3,6,12 and 24 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Sep 2007 (estimated)
  2. Study startJan 2007
  3. Primary completionDec 2016
  4. Study completion3 Apr 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
203 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00524719
Sponsor's protocol ID
GEN # 05-014
Acronym
DRF
Status last verified
May 2020
First submitted
4 Sep 2007
Last updated
11 May 2020
Results posted
No
Data monitoring committee
No
Individual data sharing
No

Publications

  • Larsen CF, Lauritsen J. Epidemiology of acute wrist trauma. Int J Epidemiol. 1993 Oct;22(5):911-6. doi: 10.1093/ije/22.5.911.

    PubMed 8282472
  • Nguyen TV, Center JR, Sambrook PN, Eisman JA. Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: the Dubbo Osteoporosis Epidemiology Study. Am J Epidemiol. 2001 Mar 15;153(6):587-95. doi: 10.1093/aje/153.6.587.

    PubMed 11257067
  • Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178-208. doi: 10.1093/oxfordjournals.epirev.a036281. No abstract available.

    PubMed 3902494
  • Papadimitropoulos EA, Coyte PC, Josse RG, Greenwood CE. Current and projected rates of hip fracture in Canada. CMAJ. 1997 Nov 15;157(10):1357-63.

    PubMed 9371065
  • Goeree R, O'Brien B, Pettit D, Cuddy L, Ferraz M, Adachi JD. An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can 1996; 18 suppl (July):15-24. 4.

  • Ray NF, Chan JK, Thamer M, Melton LJ 3rd. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997 Jan;12(1):24-35. doi: 10.1359/jbmr.1997.12.1.24.

    PubMed 9240722
  • van Leeuwen PA, Reynders PA, Rommens PM, Broos PL. Operative treatment of Smith-Goyrand fractures. Injury. 1990 Nov;21(6):358-60. doi: 10.1016/0020-1383(90)90118-e.

    PubMed 2276796
  • Oskam J, Kingma J, Klasen HJ. Fracture of the distal forearm: epidemiological developments in the period 1971-1995. Injury. 1998 Jun;29(5):353-5. doi: 10.1016/s0020-1383(97)00212-x.

    PubMed 9813678
  • Gliatis JD, Plessas SJ, Davis TR. Outcome of distal radial fractures in young adults. J Hand Surg Br. 2000 Dec;25(6):535-43. doi: 10.1054/jhsb.2000.0373.

    PubMed 11106514
  • Szabo RM. Extra-articular fractures of the distal radius. Orthop Clin North Am. 1993 Apr;24(2):229-37.

    PubMed 8479721
  • Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury. 2000 Mar;31(2):75-9. doi: 10.1016/s0020-1383(99)00207-7.

    PubMed 10748808
  • Kazuki K, Kusunoki M, Yamada J, Yasuda M, Shimazu A. Cineradiographic study of wrist motion after fracture of the distal radius. J Hand Surg Am. 1993 Jan;18(1):41-6. doi: 10.1016/0363-5023(93)90242-U.

    PubMed 8423316
  • McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg Br. 1988 Aug;70(4):649-51. doi: 10.1302/0301-620X.70B4.3403617.

    PubMed 3403617
  • Board T, Kocialkowski A, Andrew G. Does Kapandji wiring help in older patients? A retrospective comparative review of displaced intra-articular distal radial fractures in patients over 55 years. Injury. 1999 Dec;30(10):663-9. doi: 10.1016/s0020-1383(99)00167-9.

    PubMed 10707240
  • Stoffelen DV, Broos PL. Closed reduction versus Kapandji-pinning for extra-articular distal radial fractures. J Hand Surg Br. 1999 Feb;24(1):89-91. doi: 10.1016/s0266-7681(99)90045-1.

    PubMed 10190614

Questions about this trial

What is this clinical trial studying?

A study testing Open Reduction and Internal Fixation, Non-Spanning External Fixation and Closed Reduction with Percutaneous Fixation in people with Distal Radius Fractures, run by McGill University Health Centre/Research Institute of the McGill University Health Centre at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 May 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Primary Outcome Variable: Validated functional outcome tools to be used: patient rated wrist evaluation (PRWE) disability shoulder, arm, hand (DASH) short musculoskeletal functional assessment (SMFA) (time frame: 6 weeks; 3,6,12 and 24 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00524719, which also lists 60 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 May 2020.

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