Return to work after volar or combined plating of type C distal radius fracture: a secondary analysis of a randomised clinical trial

TL;DR

This study found that combined plating for type C distal radius fractures leads to longer sick leave compared to volar plating, suggesting less invasive treatment is better for quicker return to work.

Contribution

The study provides new evidence on the impact of surgical technique on return-to-work time for type C distal radius fractures.

Findings

Combined plating resulted in a 0.65-month longer sick leave compared to volar plating.

More invasive treatments like combined plating are associated with higher costs due to extended sick leave.

Soft tissue dissection may explain the longer recovery time in the combined plating group.

Abstract

Distal radius fracture (DRF) is the most common of fractures, accounting for 18% of all fractures. The ability to return to work is an important outcome for both society and the individual, but there is a large variation among patients in how much time off work is required. The choice of treatment is likely an important factor.

This study was a secondary analysis of an earlier published randomised clinical trial comparing volar locking plate fixation with combined dorsal and volar plate fixation of AO type C DRF. In the present study, we examined the the duration of sick leave among patients who were in the workforce at the time of fracture.

There were 84 cases included in this analysis.Combined plating was associated with a significantly longer time to return to work following a type C DRF, in comparison to treatment with a volar locking plate. The crude difference was 0.67 months (p = 0.33; 95% CI: 0.85–1,26 months), and 0.65 months (p = 0.15; 95% CI: 0.13–1.17) when adjusting for differences in manual labour indicating a statistically significant difference time until return to work.

Sick leave is an important contributor to total costs in patients with DRF, and more invasive treatments like combined plating are associated with longer sick leave. Our results indicate a longer time until return to work in the combined plating group, possibly due to more extensive soft tissue dissection. We recommend a restrictive use of combined plating.

The study was registered in the Swedish research database FoU in Sweden (registration number: 274674) on the 4th of August 2020.

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