Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Maria Wilcke, Karolinska Institutet, Sweden
- Second opponent: Associate Professor Yngvar Krukhaug, University of Bergen, Norway
- Third member and chair of the evaluation committee: Professor Per-Henrik Randsborg, University of Oslo
Chair of the Defence
Professor Emeritus Johan Ræder, University of Oslo
Principal Supervisor
Professor II Wender Figved, University of Oslo
Summary
The introduction of low-profile volar locking plates for distal radius fractures two decades ago has transformed treatment practices, replacing traditional methods like K-wire fixation, external fixation and dorsal plates. Despite their advantages, this shift also raised concerns about the potential for treatment-related complications due to the more invasive volar surgical approach.
This thesis aimed to compare clinical outcomes of volar locking plates (VLPs, via the volar approach) and dorsal nail plates (DNPs, via the dorsal approach) for extra-articular distal radius fractures in patients aged 55 and older, both utilizing modern low-profile locking technology. Additionally, it assessed the impact of pronator quadratus (PQ) muscle rupture on patient outcomes and analysed trends in approved malpractice claims related to distal radius fractures in the Norwegian System of Patient Injury Compensation (NPE) between 2009 to 2018.
A randomized controlled trial (RCT) demonstrated equivalent QuickDASH scores and similar complication rates between VLP and DNP after one year. A secondary analysis of VLP patients indicated that PQ rupture did not significantly affect patient-reported outcomes, though those with intact PQ had marginally better EQ-5D index scores and baseline grip strength.
An analysis of data from the NPE and the Norwegian Patient Registry, showed a significant decline in approved claims over the study period, corresponding with increased use of plates, which accounted for 94% of surgeries by 2018. Approved claims were less frequent for non-operative treatment but higher for K-wire fixation and external fixation compared to plates. The incidence of approved claims was higher for those under 65.
In conclusion, the RCT supports DNP as an effective alternative to VLP in extraarticular distal radius fractures. PQ rupture appeared to have minimal impact on outcomes. The reduction in approved claims coincided with the growing preference for plate fixation in Norway.
Additional information
Contact the research support staff.