{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T09:16:27Z","timestamp":1792746987523,"version":"4.5.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is no consensus as to whether displaced extra-articular distal radial fractures should be treated operatively or nonoperatively. We compared the outcomes of open reduction and volar plate fixation with closed reduction and plaster immobilization in adults with an acceptably reduced extra-articular distal radial fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this multicenter randomized controlled trial, patients 18 to 75 years old with an acceptably reduced extra-articular distal radial fracture were randomly assigned to open reduction and volar plate fixation or plaster immobilization. The primary outcome was function as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire after 12 months. Follow-up was conducted at 1, 3, and 6 weeks and at 3, 6, and 12 months. Analyses were performed according to the intention-to-treat principle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Ninety-two patients were randomized, 48 to open reduction and volar plate fixation and 44 to plaster immobilization; 1 patient in each group was excluded for withdrawing informed consent. At all follow-up time points, operatively treated patients had significantly better functional outcomes, as indicated by significantly lower DASH scores, than patients treated nonoperatively (all p values &lt; 0.05). Twelve nonoperatively managed patients (28%) had fracture redisplacement within 6 weeks and underwent subsequent open reduction and internal fixation, and 6 patients (14%) had a symptomatic malunion treated with corrective osteotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Patients with an acceptably reduced extra-articular distal radial fracture treated with open reduction and volar plate fixation have better functional outcomes after 12 months compared with nonoperatively managed patients. Additionally, 42% of nonoperatively managed patients had a subsequent surgical procedure. Open reduction and volar plate fixation should be considered for patients who experience this common injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.18.00693","type":"journal-article","created":{"date-parts":[[2019,5,2]],"date-time":"2019-05-02T07:33:00Z","timestamp":1556782380000},"page":"787-796","source":"Crossref","is-referenced-by-count":91,"title":["Volar Plate Fixation Versus Plaster Immobilization in Acceptably Reduced Extra-Articular Distal Radial Fractures"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0575-0447","authenticated-orcid":false,"given":"Marjolein A.M.","family":"Mulders","sequence":"first","affiliation":[{"name":"Trauma Unit (M.A.M.M. and M.M.J.W.), Department of Surgery (S.v.D.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1371-7687","authenticated-orcid":false,"given":"Monique M.J.","family":"Walenkamp","sequence":"additional","affiliation":[{"name":"Trauma Unit (M.A.M.M. and M.M.J.W.), Department of Surgery (S.v.D.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3084-0495","authenticated-orcid":false,"given":"Susan","family":"van Dieren","sequence":"additional","affiliation":[{"name":"Trauma Unit (M.A.M.M. and M.M.J.W.), Department of Surgery (S.v.D.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3942-0304","authenticated-orcid":false,"given":"J. Carel","family":"Goslings","sequence":"additional","affiliation":[{"name":"Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6475-7286","authenticated-orcid":false,"given":"Niels W.L.","family":"Schep","sequence":"additional","affiliation":[{"name":"Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the VIPER Trial Collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"3","key":"bib1-20230811","first-page":"357","article-title":"Incidence and characteristics of distal radial fractures in an urban population in The Netherlands","volume":"40","author":"Bentohami","year":"2014","journal-title":"Eur J Trauma Emerg Surg."},{"issue":"7","key":"bib2-20230811","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1302\/0301-620X.96B7.33149","article-title":"The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study","volume":"96-B","author":"Mellstrand-Navarro","year":"2014","journal-title":"Bone Joint J."},{"issue":"3","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"180","DOI":"10.5435\/00124635-201003000-00007","article-title":"Treatment of distal radius fractures","volume":"18","author":"Lichtman","year":"2010","journal-title":"J Am Acad Orthop Surg."},{"issue":"4","key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/BOT.0b013e31819b24e9","article-title":"A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating","volume":"23","author":"Arora","year":"2009","journal-title":"J Orthop Trauma."},{"issue":"23","key":"bib6-20230811","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.2106\/JBJS.J.01597","article-title":"A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older","volume":"93","author":"Arora","year":"2011","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib7-20230811","first-page":"1944","article-title":"Prediction of instability in distal radial fractures","volume":"88","author":"Mackenney","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib8-20230811","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1177\/1753193415604795","article-title":"Predictors of unstable distal radius fractures: a systematic review and meta-analysis","volume":"41","author":"Walenkamp","year":"2016","journal-title":"J Hand Surg Eur Vol."},{"issue":"8","key":"bib9-20230811","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1016\/j.jhsa.2008.04.031","article-title":"Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment","volume":"33","author":"Makhni","year":"2008","journal-title":"J Hand Surg Am."},{"issue":"38","key":"bib10-20230811","first-page":"182","article-title":"On the fracture of the carpal extremity of the radius","volume":"10","author":"Colles","year":"1814","journal-title":"Edinb Med Surg J."},{"issue":"4","key":"bib11-20230811","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1302\/0301-620X.70B4.3403617","article-title":"Colles fracture: does the anatomical result affect the final function?","volume":"70","author":"McQueen","year":"1988","journal-title":"J Bone Joint Surg Br."},{"issue":"7","key":"bib12-20230811","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.jhsa.2007.05.009","article-title":"The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients","volume":"32","author":"Grewal","year":"2007","journal-title":"J Hand Surg Am."},{"issue":"6","key":"bib13-20230811","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.otsr.2017.01.017","article-title":"Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries","volume":"103","author":"Mulders","year":"2017","journal-title":"Orthop Traumatol Surg Res."},{"issue":"6","key":"bib14-20230811","first-page":"577","article-title":"Efficacy of closed reduction and maintenance of surgical outcome in plaster cast immobilization in different types of distal radius fractures","volume":"9","author":"Kulej","year":"2007","journal-title":"Ortop Traumatol Rehabil."},{"issue":"206","key":"bib15-20230811","first-page":"202","article-title":"Long-term results of conservative treatment of fractures of the distal radius","author":"Altissimi","year":"1986","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib16-20230811","doi-asserted-by":"crossref","first-page":"354","DOI":"10.2106\/00004623-200203000-00004","article-title":"Closed reduction of colles fractures: comparison of manual manipulation and finger-trap traction: a prospective, randomized study","volume":"84-A","author":"Earnshaw","year":"2002","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib17-20230811","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1302\/0301-620X.69B3.3584203","article-title":"The value of early mobilisation in the treatment of Colles\u2019 fractures","volume":"69","author":"Dias","year":"1987","journal-title":"J Bone Joint Surg Br."},{"key":"bib18-20230811","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/1471-2474-15-90","article-title":"Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial","volume":"15","author":"Walenkamp","year":"2014","journal-title":"BMC Musculoskelet Disord."},{"issue":"6","key":"bib19-20230811","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L","article-title":"The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected] [corrected]","volume":"29","author":"Hudak","year":"1996","journal-title":"Am J Ind Med."},{"issue":"8","key":"bib20-20230811","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1097\/00005131-199811000-00009","article-title":"Patient rating of wrist pain and disability: a reliable and valid measurement tool","volume":"12","author":"MacDermid","year":"1998","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib21-20230811","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.jhsa.2012.12.032","article-title":"Minimal clinically important differences of 3 patient-rated outcomes instruments","volume":"38","author":"Sorensen","year":"2013","journal-title":"J Hand Surg Am."},{"issue":"6","key":"bib22-20230811","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med Care."},{"issue":"10","key":"bib23-20230811","doi-asserted-by":"crossref","first-page":"3235","DOI":"10.1007\/s11999-015-4376-9","article-title":"The minimum clinically important difference of the patient-rated wrist evaluation score for patients with distal radius fractures","volume":"473","author":"Walenkamp","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib24-20230811","doi-asserted-by":"crossref","first-page":"715","DOI":"10.2307\/2530051","article-title":"Analysis of covariance using the rank transformation","volume":"38","author":"Conover","year":"1982","journal-title":"Biometrics."},{"key":"bib25-20230811","doi-asserted-by":"crossref","first-page":"e5840","DOI":"10.1136\/bmj.e5840","article-title":"Reporting and analysis of trials using stratified randomisation in leading medical journals: review and reanalysis","volume":"345","author":"Kahan","year":"2012","journal-title":"BMJ."},{"issue":"9","key":"bib26-20230811","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.2106\/JBJS.G.01569","article-title":"Fractures of the distal part of the radius. The evolution of practice over time. Where\u2019s the evidence?","volume":"90","author":"Koval","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib27-20230811","first-page":"939","article-title":"Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland","volume":"71","author":"Mattila","year":"2011","journal-title":"J Trauma."},{"issue":"4","key":"bib28-20230811","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s00264-007-0355-4","article-title":"Can radiological results be surrogate markers of functional outcome in distal radial extra-articular fractures?","volume":"32","author":"Kumar","year":"2008","journal-title":"Int Orthop."},{"issue":"8","key":"bib29-20230811","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1016\/j.jhsa.2018.05.003","article-title":"Association between radiological and patient-reported outcome in adults with a displaced distal radius fracture: a systematic review and meta-analysis","volume":"43","author":"Mulders","year":"2018","journal-title":"J Hand Surg Am."},{"issue":"46","key":"bib30-20230811","first-page":"779","article-title":"The treatment of displaced intra-articular distal radius fractures in elderly patients","volume":"111","author":"Bartl","year":"2014","journal-title":"Dtsch Arztebl Int."},{"issue":"9","key":"bib31-20230811","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.2106\/JBJS.I.00968","article-title":"Distal radial fractures in the elderly: operative compared with nonoperative treatment","volume":"92","author":"Egol","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib32-20230811","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.2106\/JBJS.H.01111","article-title":"Is early internal fixation preferred to cast treatment for well-reduced unstable distal radial fractures?","volume":"91","author":"Koenig","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib33-20230811","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1177\/1753193417730323","article-title":"Functional outcomes of distal radius fractures with and without ulnar styloid fractures: a meta-analysis","volume":"43","author":"Mulders","year":"2018","journal-title":"J Hand Surg Eur Vol."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201905010-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:34:56Z","timestamp":1787751296000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201905010-00004"}},"subtitle":["A Multicenter Randomized Controlled Trial"],"short-title":[],"issued":{"date-parts":[[2019,5,1]]},"references-count":32,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.18.00693","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,1]]}}}