{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:42:35Z","timestamp":1792197755106,"version":"4.4.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2020,12,24]],"date-time":"2020-12-24T00:00:00Z","timestamp":1608768000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The use of volar locking plate fixation (VLP) for unstable extra-articular distal radial fractures has increased in the last decades. External fixation (EF) is less frequently used. This change of surgical approach has only to some extent been evidence-based.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this multicenter, randomized controlled trial, we compared VLP and EF in patients between 18 and 70 years of age who had a displaced extra-articular distal radial fracture (OTA\/AO type A3). The patients were examined at 6 weeks, 3 months, and 1 year postoperatively. The primary outcome measure was the Patient-Rated Wrist\/Hand Evaluation score (PRWHE). Secondary outcomes were the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain score on a visual analog scale (VAS), and radiographic measurements. Range of motion, grip strength, finger stiffness, complications, and reoperations were also recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>One hundred and fifty-six patients were included. One hundred and forty-two (91%)\u2014127 women (89%) and 15 men (11%)\u2014completed 1 year of follow-up. Sixty-nine patients were treated with VLP and 73, with EF. The mean age was 56 years. At 6 weeks, the median PRWHE score was significantly higher in the EF group (44) compared with the VLP group (27) (p &lt; 0.001). At 3 months and 1 year, the difference between groups was not significant. The median QuickDASH score was 27 in the VLP group and 43 in the EF group at 6 weeks (p &lt; 0.001), and a significant difference persisted at 3 months (p = 0.023). The VLP group had superior results in terms pain during activity, wrist extension, and ulnar and radial deviation at 1 year, whereas the number of major complications was similar in the 2 groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Patients treated with VLP had earlier recovery of function compared with patients treated with EF. One year postoperatively, we found no significant functional difference.<\/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.20.00275","type":"journal-article","created":{"date-parts":[[2020,12,24]],"date-time":"2020-12-24T15:57:11Z","timestamp":1608825431000},"page":"405-414","source":"Crossref","is-referenced-by-count":17,"title":["Surgical Treatment of Distal Radial Fractures with External Fixation Versus Volar Locking Plate"],"prefix":"10.2106","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8082-9617","authenticated-orcid":false,"given":"Trine","family":"Ludvigsen","sequence":"first","affiliation":[{"name":"University of Bergen, Bergen, Norway"},{"name":"Division of Orthopaedic Surgery, Voss Hospital, Voss, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9567-6112","authenticated-orcid":false,"given":"Kjell","family":"Matre","sequence":"additional","affiliation":[{"name":"University of Bergen, Bergen, Norway"},{"name":"Division of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0890-3496","authenticated-orcid":false,"given":"Rakel Sif","family":"Gudmundsdottir","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1289-5185","authenticated-orcid":false,"given":"Yngvar","family":"Krukhaug","sequence":"additional","affiliation":[{"name":"University of Bergen, Bergen, Norway"},{"name":"Division of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6886-9701","authenticated-orcid":false,"given":"Eva Hansen","family":"Dybvik","sequence":"additional","affiliation":[{"name":"Norwegian National Advisory Unit on Arthroplasty and Hip Fractures, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7227-3639","authenticated-orcid":false,"given":"Jonas Meling","family":"Fevang","sequence":"additional","affiliation":[{"name":"University of Bergen, Bergen, Norway"},{"name":"Division of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,12,24]]},"reference":[{"issue":"3","key":"bib1-20231204","doi-asserted-by":"crossref","first-page":"263","DOI":"10.3109\/02844319509050137","article-title":"Fractures of the distal radius in a Norwegian city","volume":"29","author":"Hove","year":"1995","journal-title":"Scand J Plast Reconstr Surg Hand Surg."},{"issue":"6","key":"bib2-20231204","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1007\/s00198-007-0499-5","article-title":"Epidemiology of distal forearm fractures in Oslo, Norway","volume":"19","author":"Lofthus","year":"2008","journal-title":"Osteoporos Int."},{"issue":"2","key":"bib3-20231204","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1302\/0301-620X.93B2.25631","article-title":"What are the radiological predictors of functional outcome following fractures of the distal radius?","volume":"93","author":"Ng","year":"2011","journal-title":"J Bone Joint Surg Br."},{"issue":"7","key":"bib4-20231204","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":"10","key":"bib5-20231204","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1302\/0301-620X.90B10.21293","article-title":"A revolution in the management of fractures of the distal radius?","volume":"90","author":"Downing","year":"2008","journal-title":"J Bone Joint Surg Br."},{"issue":"9","key":"bib6-20231204","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":"9","key":"bib7-20231204","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1302\/0301-620X.90B9.20521","article-title":"Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial","volume":"90","author":"Egol","year":"2008","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"bib8-20231204","doi-asserted-by":"crossref","first-page":"311","DOI":"10.2106\/JBJS.18.00014","article-title":"Volar locking plates versus augmented external fixation of intra-articular distal radial fractures: functional results from a randomized controlled trial","volume":"101","author":"Hammer","year":"2019","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib9-20231204","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.injury.2011.05.021","article-title":"Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation \u2018versus\u2019 locked volar plating","volume":"43","author":"Jeudy","year":"2012","journal-title":"Injury."},{"issue":"19","key":"bib10-20231204","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.2106\/JBJS.L.00232","article-title":"Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial","volume":"95","author":"Karantana","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib11-20231204","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/BOT.0000000000000519","article-title":"Volar locking plate or external fixation with optional addition of k-wires for dorsally displaced distal radius fractures: a randomized controlled study","volume":"30","author":"Mellstrand Navarro","year":"2016","journal-title":"J Orthop Trauma."},{"issue":"1","key":"bib12-20231204","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jhsa.2014.09.025","article-title":"A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures","volume":"40","author":"Roh","year":"2015","journal-title":"J Hand Surg Am."},{"issue":"1","key":"bib13-20231204","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jhsa.2018.09.015","article-title":"External fixation versus volar locking plate for unstable dorsally displaced distal radius fractures-a 3-year follow-up of a randomized controlled study","volume":"44","author":"Saving","year":"2019","journal-title":"J Hand Surg Am."},{"issue":"7","key":"bib14-20231204","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.2106\/JBJS.H.00722","article-title":"Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial","volume":"91","author":"Wei","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib15-20231204","doi-asserted-by":"crossref","first-page":"76","DOI":"10.3109\/17453674.2011.552781","article-title":"Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year","volume":"82","author":"Wilcke","year":"2011","journal-title":"Acta Orthop."},{"issue":"8","key":"bib16-20231204","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1016\/j.jhsa.2013.04.039","article-title":"Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures: a randomized, controlled study","volume":"38","author":"Williksen","year":"2013","journal-title":"J Hand Surg Am."},{"issue":"7","key":"bib17-20231204","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/j.jhsa.2015.03.008","article-title":"External fixation and adjuvant pins versus volar locking plate fixation in unstable distal radius fractures: a randomized, controlled study with a 5-year follow-up","volume":"40","author":"Williksen","year":"2015","journal-title":"J Hand Surg Am."},{"issue":"6","key":"bib18-20231204","doi-asserted-by":"crossref","first-page":"602","DOI":"10.4103\/ortho.IJOrtho_601_16","article-title":"Volar locking plate versus external fixation for distal radius fractures: a meta-analysis of randomized controlled trials","volume":"52","author":"Fu","year":"2018","journal-title":"Indian J Orthop."},{"issue":"9","key":"bib19-20231204","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1177\/1753193417743936","article-title":"Volar locking plate fixation versus external fixation of distal radius fractures: a meta-analysis","volume":"43","author":"Gouk","year":"2018","journal-title":"J Hand Surg EurVol."},{"issue":"1","key":"bib20-20231204","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.jss.2014.06.018","article-title":"Volar locking plate versus external fixation for the treatment of unstable distal radial fractures: a meta-analysis of randomized controlled trials","volume":"193","author":"Li-hai","year":"2015","journal-title":"J Surg Res."},{"issue":"2","key":"bib21-20231204","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s11751-013-0169-4","article-title":"Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis","volume":"8","author":"Walenkamp","year":"2013","journal-title":"Strategies Trauma Limb Reconstr."},{"issue":"5","key":"bib22-20231204","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.aott.2018.06.001","article-title":"Is volar locking plate superior to external fixation for distal radius fractures? A comprehensive meta-analysis","volume":"52","author":"Wang","year":"2018","journal-title":"Acta Orthop Traumatol Turc."},{"issue":"9","key":"bib23-20231204","doi-asserted-by":"crossref","first-page":"e2945","DOI":"10.1097\/MD.0000000000002945","article-title":"Internal versus external fixation for the treatment of distal radial fractures: a systematic review of overlapping meta-analyses","volume":"95","author":"Zhang","year":"2016","journal-title":"Medicine (Baltimore)."},{"issue":"Suppl 1","key":"bib24-20231204","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification compendium-2018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib25-20231204","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":"10","key":"bib26-20231204","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":"6","key":"bib27-20231204","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":"5","key":"bib28-20231204","first-page":"1038","article-title":"Development of the QuickDASH: comparison of three item-reduction approaches","volume":"87","author":"Beaton","year":"2005","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib29-20231204","first-page":"1070","article-title":"[Norwegian version of the DASH questionnaire for examination of the arm shoulders and hand]","volume":"128","author":"Finsen","year":"2008","journal-title":"Tidsskr Nor Laegeforen."},{"issue":"20","key":"bib30-20231204","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.4045\/tidsskr.13.1163","article-title":"The PRWHE form in Norwegian\u2014assessment of hand and wrist afflictions","volume":"133","author":"Reigstad","year":"2013","journal-title":"Tidsskr Nor Laegeforen."},{"issue":"2","key":"bib31-20231204","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0039-6109(05)70381-9","article-title":"Measurement of pain","volume":"79","author":"Katz","year":"1999","journal-title":"Surg Clin North Am."},{"issue":"6","key":"bib32-20231204","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1302\/0301-620X.97B6.33844","article-title":"Is it time to revisit the AO classification of fractures of the distal radius? Inter- and intra-observer reliability of the AO classification","volume":"97-B","author":"Plant","year":"2015","journal-title":"Bone Joint J."},{"issue":"2","key":"bib33-20231204","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J Chiropr Med."},{"issue":"4","key":"bib34-20231204","doi-asserted-by":"crossref","first-page":"820","DOI":"10.2106\/00004623-195436040-00013","article-title":"Grip test; the use of a dynamometer with adjustable handle spacings","volume":"36-A","author":"Bechtol","year":"1954","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib35-20231204","first-page":"234","article-title":"Grip strength: effect of hand dominance","volume":"43","author":"Incel","year":"2002","journal-title":"Singapore Med J."},{"issue":"7","key":"bib36-20231204","doi-asserted-by":"crossref","first-page":"444","DOI":"10.5014\/ajot.43.7.444","article-title":"Grip strength and hand dominance: challenging the 10% rule","volume":"43","author":"Petersen","year":"1989","journal-title":"Am J Occup Ther."},{"issue":"2","key":"bib37-20231204","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.pain.2010.04.030","article-title":"Validation of proposed diagnostic criteria (the \u201cBudapest Criteria\u201d) for Complex Regional Pain Syndrome","volume":"150","author":"Harden","year":"2010","journal-title":"Pain."},{"key":"bib38-20231204","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1471-2474-4-24","article-title":"Pain and disability reported in the year following a distal radius fracture: a cohort study","volume":"4","author":"MacDermid","year":"2003","journal-title":"BMC Musculoskelet Disord."},{"issue":"7","key":"bib39-20231204","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/BOT.0b013e318225f63c","article-title":"External fixation versus internal fixation for unstable distal radius fractures: a systematic review and meta-analysis of comparative clinical trials","volume":"26","author":"Wei","year":"2012","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib40-20231204","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3109\/17453674.2013.792029","article-title":"Comparison of internal and external fixation of distal radius fractures","volume":"84","author":"Xie","year":"2013","journal-title":"Acta Orthop."},{"issue":"3","key":"bib41-20231204","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/S0363-5023(82)80183-4","article-title":"Ulnar variance\u2014the effect of wrist positioning and roentgen filming technique","volume":"7","author":"Epner","year":"1982","journal-title":"J Hand Surg Am."},{"issue":"6","key":"bib42-20231204","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1053\/jhsu.2001.26657","article-title":"Effects of forearm rotation on the clinical evaluation of ulnar variance","volume":"26","author":"Yeh","year":"2001","journal-title":"J Hand Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.00275","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:41:36Z","timestamp":1787751696000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.00275"}},"subtitle":["A Multicenter Randomized Controlled Trial"],"short-title":[],"issued":{"date-parts":[[2020,12,24]]},"references-count":42,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.20.00275","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,24]]}}}