Study rationale
The Drift trial is a NITEP (The Nordic DeltaCon ) trial, a randomized, multicenter investigation comparing operative and non-operative treatment for distal radius fractures (DRFs) in patients aged 65 and over. DRFs are among the most common fragility fractures in the older patients, often due to low-energy trauma such as falls. Despite their frequency, optimal treatment—especially in older adults—remains debated. Surgical approaches, like volar locking plate fixation, have gained popularity over recent decades, although evidence on their superiority remains limited, especially in older populations with lower functional demands.
This trial is significant because it aims to fill a critical evidence gap. Although volar locking plates are commonly used, particularly in younger and more active patients, it remains uncertain whether the benefits justify surgical risks in the elderly. The Drift trial seeks to inform future guidelines and enhance personalized care for older adults with distal radius fractures by providing high-level evidence across functional, safety, and economic domains.
Study design
The Drift trial targets explicitly patients with initially or early (after ca. 10 days) malaligned distal radius fractures. Participants are randomized to receive either operative treatment using a volar locking plate or non-operative management involving cast immobilization. The trial is designed to evaluate which strategy provides better outcomes regarding function, recovery, complications, and cost-effectiveness.
The primary endpoint is the Patient-Rated Wrist Evaluation (PRWE) score two years post-treatment, a widely accepted tool to assess wrist pain and function. Secondary endpoints include other patient-reported outcome measures (PROMs), pain levels, range of motion, grip strength, rates of complications and reoperations, and overall quality of life using validated instruments. By incorporating both subjective and objective measures, the study aims to assess the impact of each treatment approach comprehensively.
An additional focus of the study is health economics. As healthcare systems face increasing demands, understanding not only clinical outcomes but also cost-effectiveness is essential. Thus, the study includes analyzing resource use and economic outcomes associated with both treatments. Recruitment spans several Nordic centers to ensure broader applicability of the findings, and ethical approval and trial registration support its methodological rigor.
Status
Recruitment is finished and primary results are being analyzed