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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Bjarke Løvbjerg Viberg, University of Southern Denmark,
- Second opponent: Professor Christina Brudvik, University of Bergen, Norway
- Third member and chair of the evaluation committee: Associate Professor Johannes Kurt Schultz, University of Oslo
Chair of the Defence
Associate Professor Knut Magne Augestad, University of Oslo
Principal Supervisor
Professor Per-Henrik Randsborg, University of Oslo
Summary
Distal radius fractures (DRFs) pose a significant clinical and socioeconomic challenge, especially in older populations. As surgical techniques have advanced, particularly with the advent of volar locking plates (VLP), the treatment of DRFs has transitioned from conservative methods to operative management.
This dissertation explores modern surgical approaches and rehabilitation strategies for distal radius fractures (DRFs). Through four studies, the work assesses the clinical effectiveness, safety, and long-term outcomes of volar locking plate (VLP) fixation compared to external fixation (EF). It also evaluates rehabilitation protocols, investigates the clinical impact of ulnar styloid fractures (USFs), and reviews compensation claims associated with DRF treatment in Norway.
Two prospective randomised controlled trials (RCTs) included 285 patients aged 18–70 years with either intra- or extra-articular DRFs treated at Akershus University Hospital. Patients were followed for two years postoperatively, and outcomes included QuickDASH scores, grip strength, range of motion (ROM), pain (measured by VAS), and complications. A pooled secondary analysis was conducted to evaluate the impact of untreated unstable fractures (USFs). Finally, compensation claims related to DRF treatment (n=800) submitted to the Norwegian System of Patient Injury Compensation (NPE) between 2000 and 2013 were retrospectively analysed.
The results indicate that while volar locking plates enable a faster initial recovery compared to external fixation, the long-term functional outcomes are similar. Early mobilisation after surgery is safe, even if it does not provide a lasting advantage over delayed mobilisation. This suggests that structured home exercise may be sufficient for many patients. Furthermore, untreated ulnar styloid fractures did not impact long-term function or patient-reported outcomes, even in cases of non-union. A review of compensation claims revealed that most accepted cases stemmed from delayed treatment and loss of reduction during conservative management, particularly in smaller hospitals. Surgical treatment, especially with VLP, was rarely associated with upheld claims.
This dissertation supports a pragmatic, patient-centred approach to treating DRFs. Volar locking plates provide a quicker return to function but should be balanced against their cost and potential complications. Routine physiotherapy and extended casting might be unnecessary, and associated USFs do not need fixation if the DRF is stabilised. Enhancing early decision-making, particularly in conservative care, and reinforcing treatment protocols—especially in low-volume hospitals—may reduce complications. These findings support standardised, evidence-based treatment pathways to ensure high-quality care for all patients with distal radius fractures.
Additional information
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