External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures—A 3-Year Follow-Up of a Randomized Controlled Study

Saving, Jenny; Enocson, Anders; Ponzer, Sari; Navarro, Cecilia Mellstrand

doi:10.1016/j.jhsa.2018.09.015

Cited by 46 publications

(44 citation statements)

References 56 publications

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“…We conclude that the differences might be resulting from the variations in study design, patient characteristics, data collection, and duration of the follow-up period. However, the similar radiological results with respect to postoperative inclination, volar tilt, and radial length between the treatment modalities are in accordance with the previous reports [9,17]. However, it should be noted that radiological and functional findings might not be correlated for all patients with distal radius fractures treated with different surgical management methods.…”

Section: Discussionsupporting

confidence: 88%

Management of Distal Radius Fractures: Comparison of Three Methods

Ermutlu

Mert

Kovalak

et al. 2020

Cureus

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Introduction Distal radius fractures are the most common type of all extremity fractures. It is generally accepted that fractures with more than 2 mm step-off in the radiocarpal joint and greater than 10 degrees dorsal tilt should be treated surgically. However, the ideal technique for surgical management is still a point of debate. We performed cross-sectional data analysis to compare the results of three treatments methods-volar locking plate (VLP), external fixation (EF), Kirschner wire (K-wire)-in patients with distal radius fractures, and compared the clinical, functional, and radiological results Materials and methods Forty-four patients with distal radius fractures who underwent fixation with VLP, K-wire or EF between 2011 and 2013 were included in the study. All fractures were classified according to the Müller's Arbeitsgemeinschaft für Osteosynthesefragen (AO) and Frykman's classifications. Routine radiographs were taken at the postoperative three weeks, six weeks, and three months. Radial inclination, volar tilt, radial length and ulnar variance were assessed on the follow-up visits and additionally at the follow-up for the study. The patient-based Disabilities of the Arm, Shoulder and Hand (DASH) score system and the physician-based MAYO scale were used to evaluate functional outcomes. Radiological and functional outcomes between three surgical modalities were compared and statistically analyzed. Results The average age at the time of surgery was 52 years (range = 35-69 years). Of a total of 44 patients, 28 were operated with VLP, 11 were with K-wire and five with EF. Satisfactory reduction was achieved in all fractures, and all of the fractures healed. DASH and MAYO scores were similar in all groups. Regarding radiographic parameters, there was no significant difference in radial inclination, volar tilt, radial length and ulnar variance between the treatment modality groups. When evaluated based on fracture geometry, the DASH score was significantly higher in the patients with AO23A type fracture compared to the patients with AO23B and AO23C type fractures. As for MAYO score, all AO23 groups had similar outcomes. Conclusions Surgical treatment options VLP, EF, and K-wire provide adequate fixation, satisfactory radiological, and functional results for the management of distal radius fractures of various 1 2 3 4 5 6

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Section: Discussionsupporting

confidence: 88%

Management of Distal Radius Fractures: Comparison of Three Methods

Ermutlu

Mert

Kovalak

et al. 2020

Cureus

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“…Further, no difference could be seen in pain and activity in both operative technique groups and concluded that fixation with an external fixator is superior to open reduction internal fixation (ORIF) with volar-locked plating one-year postop [1]. Saving et al in an RCT of 118 patients of unstable distal radius fracture treated with a volar locking plate or an external fixator found comparable functional results in both groups with a higher incidence of arthrosis and reoperation rates in the volar locking group [20]. Kapoor et al concluded in their RCT on the displaced intraarticular fractures of the distal radius that cases treated with internal fixation were least likely to develop articular complications due to better restoration of anatomy.…”

Section: Number Of Cases At Final 6 Months Follow Up As Permentioning

confidence: 99%

“…Hence, only early recovery in functions may be of benefit to some patients [18]. Shukla et al, Kreder et aland Saving et al found the use of external fixation to be superior to internal fixation [1,[19][20]. Kreder et al had conducted an RCT for displaced intraarticular fractures of the distal radius and found that during the two-year follow-up, patients undergoing indirect reduction and external fixation had a more rapid return to function and were found to have a better functional outcome as compared to the internal fixation group, provided articular step and gap deformity were minimized [19].…”

Section: Number Of Cases At Final 6 Months Follow Up As Permentioning

confidence: 99%

Prospective Randomized Study Comparing the External Fixator and Volar Locking Plate in Intraarticular Distal Radius Fractures: Which Is Better?

Sharma

Pathak

Sandhu

et al. 2020

Cureus

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Introduction Various treatment options for patients with an intraarticular distal radius fracture are available, but in cases of comminuted fractures, these narrow down to either a volar locking plate, an external fixator, or a combination of these two. We conducted this prospective study to compare the external fixation and internal fixation of intraarticular fractures of the distal radius in terms of clinical/functional outcome and complications and with the available literature. Material and method This prospective randomized study consisted of a total number of 30 patients with intraarticular fractures of the distal end of the radius divided randomly into two groups (A and B), treated by external fixation (Group A) and volar plating (Group B), in a tertiary care institute during the study period. Result The most patients were males >50 years of age, with injury to the right dominant hand most commonly caused by a fall on an outstretched hand. As per the modified Green & O'Brien scoring system, the volar plating group showed the final result as excellent in two (13.33%), good in seven (46.6%), fair in four (26.6%), and poor in two (13.3%) whereas an excellent outcome was seen in one (6.66%), good and fair in five patients each (33.3%), and poor in four (26.66%) patients at the six months follow-up. Conclusion Overall, both fixation techniques seem to apply sufficient stabilization to restore function and retain anatomy; however, volar locking plates have certain advantages over external fixator in the early postop period in terms of earlier recovery and mobilization.

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“…[9][10][11] Other studies indicate that volar locking plates and external fixation can yield similar results. 12 Good results have been reported for combined volar and dorsal plate fixation of complex intra-articular DRFs using the pi-plate system; however, this implant has been discontinued by the manufacturer. [13][14][15] Reports on combined volar and dorsal plating of complex intra-articular fractures using modern implants are scarce.…”

mentioning

confidence: 99%

Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases

2020

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Background: The distal radius fracture (DRF) is the most common fracture in adults. For unstable intra-articular fractures, the choice of treatment is often operative. The optimal choice of fixation remains a matter of discussion. Question/Purpose: Can combined volar and dorsal plating, using a dorsal frame plate, achieve a good functional and radiographic 1-year outcome in intra-articular DRFs? Methods: In a retrospective cohort study, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate. The DRFs were operated between 2016 and 2017 and all cases were AO type C intra-articular fractures. The primary outcome was patient-reported outcome measures including radiographic examination 1 year postoperatively. Secondary outcome measures included wrist range of motion, visual analog scale (VAS) pain scores, and hand grip strength. Results: The median patient-rated wrist evaluation score was 18 points; the quick disabilities of the arm, shoulder, and hand score was 14.8 points. The median Batra radiographic score was 88. Wrist extension was 76% of the uninjured side, flexion was 74%, pronation was 94%, and supination was 94%. VAS pain scores were 0 at rest and 2 during activity. Hand grip strength was 82% compared with the uninjured side. The radiographic outcome according to Batra did not correspond to the patient-reported outcome. Patients older than 60 years had significantly better QuickDASH (quick disabilities of the arm, shoulder, and hand) and PRWE scores (patient-rated wrist evaluation scores) and less pain during activity compared with younger patients despite similar radiographic outcome. There were no tendon ruptures; hardware removal was performed in 21 of the 74 patients. Conclusion: The radiographic outcome did not correspond to the functional outcome 1 year postoperatively. Older patients report less pain and better functional outcome compared with younger patients. There were no tendon ruptures and the frequency of hardware removal was acceptable. Complex intra-articular DRFs AO type C can be managed with volar and dorsal frame-plate fixation to restore distal radius anatomy and achieve a good functional outcome.

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External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures—A 3-Year Follow-Up of a Randomized Controlled Study

Cited by 46 publications

References 56 publications

Management of Distal Radius Fractures: Comparison of Three Methods

Management of Distal Radius Fractures: Comparison of Three Methods

Prospective Randomized Study Comparing the External Fixator and Volar Locking Plate in Intraarticular Distal Radius Fractures: Which Is Better?

Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases

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