Is volar locking plate superior to external fixation for distal radius fractures? A comprehensive meta-analysis

Wang, Jie; Lu, Yandong; Cui, Yujie; Wei, Xuelei; Sun, Jing

doi:10.1016/j.aott.2018.06.001

Cited by 21 publications

(15 citation statements)

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“…Meta-analyses report that VLP is superior to EF and K-wire in terms of ulnar variance, for all types of radius fractures [14,15]. The ratio of patients with ulnar variance (both positive and negative) was similar in our study groups for all treatment methods.…”

Section: Discussionsupporting

confidence: 58%

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: 58%

Management of Distal Radius Fractures: Comparison of Three Methods

Ermutlu

Mert

Kovalak

et al. 2020

Cureus

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“…The timing of surgery for fractures of the distal radius continues to be debated. The evidence supports the position that the outcomes of locked plating are generally good for these injuries in carefully selected patients, irrespective of age (Azad et al., 2019; Chung et al., 2009; Wang et al., 2018). Functional requirements and early return to function are increasingly seen as key to the physical and psychological recovery of patients and are used to guide treatment decisions (Ikpeze et al., 2016).…”

Section: Discussionsupporting

confidence: 71%

Surgical fixation of fractures of the distal radius within 2 weeks reduces postoperative finger stiffness

Ashdown

Morris

Mckeon

et al. 2020

J Hand Surg Eur Vol

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Locked anterior plating remains the most common form of surgical fixation for displaced fractures of the distal radius. We hypothesized that delayed surgical fixation later than 2 weeks after injury contributes to poorer patient outcomes for patients with displaced or intra-articular fractures of the distal radius. We conducted a retrospective cohort study of 158 patients who underwent locked anterior plating for an intra-articular or displaced fracture of the distal radius using multiple regression analysis to identify any relationship between patient, injury or treatment factors with the patient-rated wrist and hand evaluation score or finger and wrist stiffness. There was no significant correlation between timing of surgery and functional scores. A delay in time to surgery of more than 2 weeks did correlate significantly with increased finger and thumb stiffness. However, this relationship was not seen for wrist stiffness. Our study supports the consensus that early recovery and function is facilitated by surgical fixation within 2 weeks and that delayed fixation beyond this may contribute to protracted finger stiffness. Level of evidence: IV

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“…Williksen et al [14] used both the Q-DASH and the MAYO scores; however, some surgeons used only Q-DASH scores. [4,[11][12][13] In a meta-analysis, Wang et al [15] reported that higher DASH scores were observed with ORIF, compared to EF. In contrast, one year later, in the meta-analysis of Lee et al, [16] there was no significant difference between the ORIF and EF groups in terms of the Q-DASH scores.…”

Section: Discussionmentioning

confidence: 99%

The external fixation can be a good alternative to plate-screw treatment in the surgical treatment of bilateral distal radius fractures: A retrospective cohort study

Dağtaş

Ünal

2021

Jt Dis Relat Surg

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Objectives: We aimed to compare the outcomes of two surgical treatment options, external fixator (EF) or open reduction and internal fixation (ORIF), in patients with bilateral distal radius fractures (DRFs). Patients and methods: Twenty-one patients (11 males 10 females; mean age: 40.0±16.0 years; range, 20 to 67 years) who underwent ORIF (n=10) or EF (n=11) due to bilateral DRF at between January 2011 and December 2019 were retrospectively analyzed. The Quick Disability of the Arm, Shoulder and Hand (Q-DASH) was used to calculate functional and symptomatic evaluation. The MAYO wrist scores were used to evaluate pain, functional status, ROM, and grip strength and the Michigan Hand Outcomes Questionnaire (MHOQ) was used to measure hand performance in daily life. Results: The operation time was statistically significantly longer in the ORIF group, compared to the EF group (p<0.001). Radial shortening was statistically significantly greater in the EF group, compared to the ORIF group (p<0.001). While the Q-DASH score was lower in the EF group on Day 15 and at one and two months (p<0.001, for each), it was similar between the groups at one year (p=0.507). The MAYO wrist score was higher in the EF group on Day 15 and at one and two months and one year (p<0.05, for each). While the MHOQ score was higher in the EF group on Day 15 and at one and two months (p<0.001, for each), it was similar between the groups at one year (p=0.557). Conclusion: In bilateral DRF cases, hand functions in the first two months after treatment were better in the EF group, compared to the ORIF group. This functional difference between the two groups gradually decreased in the first year and reached similar levels. Our results demonstrate that EF can be a good alternative in the surgical treatment of bilateral DRFs owing to its acceptable results, particularly in the short-term.

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Is volar locking plate superior to external fixation for distal radius fractures? A comprehensive meta-analysis

Cited by 21 publications

References 50 publications

Management of Distal Radius Fractures: Comparison of Three Methods

Management of Distal Radius Fractures: Comparison of Three Methods

Surgical fixation of fractures of the distal radius within 2 weeks reduces postoperative finger stiffness

The external fixation can be a good alternative to plate-screw treatment in the surgical treatment of bilateral distal radius fractures: A retrospective cohort study

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