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Meta-Analysis
. 2022 Dec;48(6):4333-4348.
doi: 10.1007/s00068-021-01679-z. Epub 2021 May 19.

Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis

Guido W Van Oijen  1 , Esther M M Van Lieshout  2 , Maarten R L Reijnders  1 , Anand Appalsamy  1 , Tjebbe Hagenaars  1 , Michael H J Verhofstad  1
Affiliations
Meta-Analysis

Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis

Guido W Van Oijen et al. Eur J Trauma Emerg Surg. 2022 Dec.

Abstract

Purpose: This systematic literature review aimed to make a detailed overview on the clinical and functional outcomes and to get insight into the possible superiority of a treatment method for extra-articular distal radius fractures.

Methods: Embase, Medline, Cochrane Library, Web of Science, and Google Scholar were searched for studies describing treatment results. Five treatment modalities were compared: plaster cast immobilization, K-wire fixation, volar plating, external fixation, and intramedullary fixation.

Results: Out of 7,054 screened studies, 109 were included in the analysis. Overall complication rate ranged from 9% after plaster cast treatment to 18.5% after K-wire fixation. For radiographic outcomes, only volar tilt in the plaster cast group was lower than in the other groups. Apart from better grip strength after volar plating, no clear functional differences were found across treatment groups.

Conclusion: Current literature does not provide uniform evidence to prove superiority of a particular treatment method when looking at complications, re-interventions, and long-term functional outcomes.

Keywords: Distal radius fractures; Extra-articular; Non-operative; Operative; Review; Treatment.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Pooled complication rates per treatment modality. Data are shown as pooled proportion with 95% CI
Fig. 3
Fig. 3
Pooled re-intervention rates per treatment modality. *Early, unplanned removal due to infection, loosening, failure, or other reasons. Data are shown as pooled proportion with 95% CI.
Fig. 4
Fig. 4
Radiographic outcomes per treatment modality. a Volar tilt (degrees), b Ulnar variance (mm), c Radial inclination (degrees) and d Radial height (mm). Data are shown as sample size weighted mean.
Fig. 5
Fig. 5
Range of motion and grip strength per treatment modality. a Flexion (degrees), b Extension (degrees), c Ulnar deviation (degrees), d Radial deviation (degrees), e Pronation (degrees), f Supination (degrees), g Grip strength (% of contralateral side). Data are shown as sample size weighted mean. The grey line represents the lowest values that will not cause any functional impairment (disability value [127])
Fig. 6
Fig. 6
Patient-reported outcome measures per treatment modality. a DASH score b Gartland & Werley (% good or excellent) c Gartland & Werley Score, d: VAS score for pain. Data are shown as sample size weighted mean.
Fig. 7
Fig. 7
Included studies per treatment modality per time period. Data are shown as proportion of the total included studies per treatment modality in time periods of five years (N = included studies)
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