Pulp-to-palm distance after plate fixation of a distal radius fracture corresponds to functional outcome.

The two groups were not created at random. Patients were sorted by the pulp-to-palm measurement taken four weeks after surgery, so the groups may differ in other ways that could explain the worse outcomes. Only 11 of the patients who had volar plating had a gap above zero, against 25 after combined plating. With numbers this small the analysis has less power, and the authors say a larger group would probably have shown differences on more of the measures. There was no pulp-to-palm measurement before surgery, so the researchers could not tell whether a patient already had a gap going into the operation. Ten patients were missing the four-week pulp-to-palm measurement and were excluded, and five more withdrew by 12 months. For smaller differences the study was underpowered. The authors' own calculation gives a power of 0.68 for a medium-sized difference and 0.16 for a small one. The QuickDASH difference at 3 months was statistically significant but did not reach the threshold the authors accept as a clinically important change.

The paper's funding statement names Orebro University. It reports no other funding source and no author disclosures in the text provided. The dorsal plates used for the combined operation were developed by the authors' own unit together with the manufacturer, Trimed Inc., which also made the implants used in the study.

Do not take this as proof that stiff fingers cause the worse outcomes. Patients were sorted into the two groups after surgery, not assigned at random, so the groups may have differed in other ways, and nothing here shows that treating the gap would improve anything. The QuickDASH difference at 3 months also fell short of the authors' own threshold for a clinically important change.