Post-Traumatic Osteoarthritis and Functional Outcomes After Volar Plating vs. Casting of Unstable Distal Radius Fractures: A Minimum 2-Year Follow-Up of the VOLCON Randomized Controlled Trial

Daniel Wæver; Rikke Thorninger; Karen Larsen Romme; Michael Tjørnild; Jan Duedal Rölfing

doi:10.3390/jcm14113766

Post-Traumatic Osteoarthritis and Functional Outcomes After Volar Plating vs. Casting of Unstable Distal Radius Fractures: A Minimum 2-Year Follow-Up of the VOLCON Randomized Controlled Trial

Daniel Wæver^*, Rikke Thorninger, Karen Larsen Romme, Michael Tjørnild, Jan Duedal Rölfing

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Background/Objectives: Distal radius fractures (DRFs) are among the most common fractures in the elderly, with increasing incidence due to population aging. Recent evidence questions the benefits of operative treatment, particularly in elderly patients. The present study aimed to assess post-traumatic osteoarthritis (OA) and patient-reported outcome measures (PROMs) after a minimum of two years of follow-up of the previously published VOLCON randomized controlled trial (RCT), which compared operative and non-operative treatments of unstable DRFs in patients aged ≥ 65 years. Methods: This study presents a minimum two-year follow-up of a single-center, assessor-blinded RCT. A total of 100 patients with unstable DRFs were randomized to either operative treatment with volar locking plating or non-operative treatment with cast immobilization. The primary outcome was post-traumatic OA, assessed using the Knirk and Jupiter classification. Secondary outcomes included PROMs (Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)) and Patient-Rated Wrist/Hand Evaluation (PRWHE), complications, pain, grip strength, and range of motion (ROM). Statistical analyses were performed using two-way ANOVA. Results: After a median follow-up of 3.0 years, 60 patients (28 non-operative and 32 operative) were available for analysis. There was no significant difference in OA between the groups (p = 0.57). PROMs (Quick-DASH, PRWHE), pain, grip strength, and ROM were time-dependent (p < 0.001) but not treatment-dependent. Complications were more frequent in the operative group, including hardware-related issues requiring reoperation. Conclusions: At a minimum of two years of follow-up, no correlation was found between treatment choice and post-traumatic OA. Functional outcomes were similar between groups, suggesting that non-operative treatment remains a viable option for elderly patients with unstable DRFs.

Original language	English
Article number	3766
Journal	Journal of Clinical Medicine
Volume	14
Issue	11
ISSN	2077-0383
DOIs	https://doi.org/10.3390/jcm14113766
Publication status	Published - Jun 2025

Keywords

distal radius fractures
non-operative treatment
post-traumatic osteoarthritis
randomized controlled trial

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@article{2bd1942ac6024d1ab5e8abd5999524a0,

title = "Post-Traumatic Osteoarthritis and Functional Outcomes After Volar Plating vs. Casting of Unstable Distal Radius Fractures: A Minimum 2-Year Follow-Up of the VOLCON Randomized Controlled Trial",

abstract = "Background/Objectives: Distal radius fractures (DRFs) are among the most common fractures in the elderly, with increasing incidence due to population aging. Recent evidence questions the benefits of operative treatment, particularly in elderly patients. The present study aimed to assess post-traumatic osteoarthritis (OA) and patient-reported outcome measures (PROMs) after a minimum of two years of follow-up of the previously published VOLCON randomized controlled trial (RCT), which compared operative and non-operative treatments of unstable DRFs in patients aged ≥ 65 years. Methods: This study presents a minimum two-year follow-up of a single-center, assessor-blinded RCT. A total of 100 patients with unstable DRFs were randomized to either operative treatment with volar locking plating or non-operative treatment with cast immobilization. The primary outcome was post-traumatic OA, assessed using the Knirk and Jupiter classification. Secondary outcomes included PROMs (Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)) and Patient-Rated Wrist/Hand Evaluation (PRWHE), complications, pain, grip strength, and range of motion (ROM). Statistical analyses were performed using two-way ANOVA. Results: After a median follow-up of 3.0 years, 60 patients (28 non-operative and 32 operative) were available for analysis. There was no significant difference in OA between the groups (p = 0.57). PROMs (Quick-DASH, PRWHE), pain, grip strength, and ROM were time-dependent (p < 0.001) but not treatment-dependent. Complications were more frequent in the operative group, including hardware-related issues requiring reoperation. Conclusions: At a minimum of two years of follow-up, no correlation was found between treatment choice and post-traumatic OA. Functional outcomes were similar between groups, suggesting that non-operative treatment remains a viable option for elderly patients with unstable DRFs.",

keywords = "distal radius fractures, non-operative treatment, post-traumatic osteoarthritis, randomized controlled trial",

author = "Daniel W{\ae}ver and Rikke Thorninger and Romme, {Karen Larsen} and Michael Tj{\o}rnild and R{\"o}lfing, {Jan Duedal}",

note = "Publisher Copyright: {\textcopyright} 2025 by the authors.",

year = "2025",

month = jun,

doi = "10.3390/jcm14113766",

language = "English",

volume = "14",

journal = "Journal of Clinical Medicine",

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Post-Traumatic Osteoarthritis and Functional Outcomes After Volar Plating vs. Casting of Unstable Distal Radius Fractures: A Minimum 2-Year Follow-Up of the VOLCON Randomized Controlled Trial. / Wæver, Daniel; Thorninger, Rikke; Romme, Karen Larsen et al.
In: Journal of Clinical Medicine, Vol. 14, No. 11, 3766, 06.2025.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Post-Traumatic Osteoarthritis and Functional Outcomes After Volar Plating vs. Casting of Unstable Distal Radius Fractures

T2 - A Minimum 2-Year Follow-Up of the VOLCON Randomized Controlled Trial

AU - Wæver, Daniel

AU - Thorninger, Rikke

AU - Romme, Karen Larsen

AU - Tjørnild, Michael

AU - Rölfing, Jan Duedal

PY - 2025/6

Y1 - 2025/6

N2 - Background/Objectives: Distal radius fractures (DRFs) are among the most common fractures in the elderly, with increasing incidence due to population aging. Recent evidence questions the benefits of operative treatment, particularly in elderly patients. The present study aimed to assess post-traumatic osteoarthritis (OA) and patient-reported outcome measures (PROMs) after a minimum of two years of follow-up of the previously published VOLCON randomized controlled trial (RCT), which compared operative and non-operative treatments of unstable DRFs in patients aged ≥ 65 years. Methods: This study presents a minimum two-year follow-up of a single-center, assessor-blinded RCT. A total of 100 patients with unstable DRFs were randomized to either operative treatment with volar locking plating or non-operative treatment with cast immobilization. The primary outcome was post-traumatic OA, assessed using the Knirk and Jupiter classification. Secondary outcomes included PROMs (Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)) and Patient-Rated Wrist/Hand Evaluation (PRWHE), complications, pain, grip strength, and range of motion (ROM). Statistical analyses were performed using two-way ANOVA. Results: After a median follow-up of 3.0 years, 60 patients (28 non-operative and 32 operative) were available for analysis. There was no significant difference in OA between the groups (p = 0.57). PROMs (Quick-DASH, PRWHE), pain, grip strength, and ROM were time-dependent (p < 0.001) but not treatment-dependent. Complications were more frequent in the operative group, including hardware-related issues requiring reoperation. Conclusions: At a minimum of two years of follow-up, no correlation was found between treatment choice and post-traumatic OA. Functional outcomes were similar between groups, suggesting that non-operative treatment remains a viable option for elderly patients with unstable DRFs.

AB - Background/Objectives: Distal radius fractures (DRFs) are among the most common fractures in the elderly, with increasing incidence due to population aging. Recent evidence questions the benefits of operative treatment, particularly in elderly patients. The present study aimed to assess post-traumatic osteoarthritis (OA) and patient-reported outcome measures (PROMs) after a minimum of two years of follow-up of the previously published VOLCON randomized controlled trial (RCT), which compared operative and non-operative treatments of unstable DRFs in patients aged ≥ 65 years. Methods: This study presents a minimum two-year follow-up of a single-center, assessor-blinded RCT. A total of 100 patients with unstable DRFs were randomized to either operative treatment with volar locking plating or non-operative treatment with cast immobilization. The primary outcome was post-traumatic OA, assessed using the Knirk and Jupiter classification. Secondary outcomes included PROMs (Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)) and Patient-Rated Wrist/Hand Evaluation (PRWHE), complications, pain, grip strength, and range of motion (ROM). Statistical analyses were performed using two-way ANOVA. Results: After a median follow-up of 3.0 years, 60 patients (28 non-operative and 32 operative) were available for analysis. There was no significant difference in OA between the groups (p = 0.57). PROMs (Quick-DASH, PRWHE), pain, grip strength, and ROM were time-dependent (p < 0.001) but not treatment-dependent. Complications were more frequent in the operative group, including hardware-related issues requiring reoperation. Conclusions: At a minimum of two years of follow-up, no correlation was found between treatment choice and post-traumatic OA. Functional outcomes were similar between groups, suggesting that non-operative treatment remains a viable option for elderly patients with unstable DRFs.

KW - distal radius fractures

KW - non-operative treatment

KW - post-traumatic osteoarthritis

KW - randomized controlled trial

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U2 - 10.3390/jcm14113766

DO - 10.3390/jcm14113766

M3 - Journal article

C2 - 40507528

AN - SCOPUS:105007923218

SN - 2077-0383

VL - 14

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 11

M1 - 3766

ER -

Post-Traumatic Osteoarthritis and Functional Outcomes After Volar Plating vs. Casting of Unstable Distal Radius Fractures: A Minimum 2-Year Follow-Up of the VOLCON Randomized Controlled Trial

Abstract

Keywords

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