Purpose: To compare the patient-reported, clinical, and radiographic outcome of 2 methods of internal fixation in distal radius fractures. Methods: Fifty patients, mean age 56 years (range, 21-69 years) with primarily nonreducible or secondarily redisplaced distal radius fractures, were randomized to open reduction and internal fixation using volar locking plates (n = 25) or fragment-specific fixation (n = 25). The patients were assessed on grip strength, range of motion, patient-reported outcome (Quick Disability of the Arm, Shoulder and Hand [QuickDASH]), pain (Visual Analog Scale [VAS]), health-related quality of life (Short Form 12 [SF-12]), and radiographic evaluation. Grip strength at 12 months was the primary outcome measure. Results: At 12 months, no difference was found in grip strength, which was 87% of the uninjured side in the volar plate group and 89% in the fragment-specific fixation group. No differences were found in the range of motion, and the median QuickDASH score was 5 in both groups. In the perioperative radiographs, 2° of volar angulation was achieved in the volar plate group versus 5° dorsal angulation in the fragment-specific group, but the difference disappeared thereafter. The overall complication rate was 21% in the volar locking plate group, compared with 52% in the fragment-specific group. Conclusions: In treatment of primarily nonreducible or secondarily redisplaced distal radius fractures, volar locking plates and fragment-specific fixation both achieve good and similar patient-reported outcomes, although more complications were recorded in the fragment-specific group.
