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. 2021 Oct;10(5):440-457.
doi: 10.1055/s-0041-1723793. Epub 2021 Feb 9.

Interventions for Distal Radius Fractures: A Meta-analysis of Comparison Studies

Julia Beyer  1 , Emily Wynkoop  1 , Jiayong Liu  1 , Nabil A Ebraheim  1
Affiliations

Interventions for Distal Radius Fractures: A Meta-analysis of Comparison Studies

Julia Beyer et al. J Wrist Surg. 2021 Oct.

Abstract

Background Distal radius fractures are one of the most frequent orthopaedic injuries. There are many effective treatment methods, such as volar plate, dorsal plate, percutaneous pins, external fixation, and casting; however, comparison of the treatment outcomes has not been thoroughly investigated. Our purpose is to determine if volar plating is the superior treatment method for distal radius fractures. We will address this through the following questions: First, is volar plating superior to dorsal plating, percutaneous pins, external fixation, or casting in terms of reported complications? Second, does volar plating produce superior functional outcomes to dorsal plating, percutaneous pins, external fixation, or casting? Third, are the radiographic outcomes superior for volar plating when compared with dorsal plating, percutaneous pins, external fixation, or casting? Methods MEDLINE, Academic Search Ultimate, Academic Search Complete, CINAHL Plus, and JSTOR databases, as well as manual search, were used to identify papers comparing complications and functional results of volar plating to other treatment methods for distal radius fractures published after the year 2000. Complication data and function scores were recorded. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data was analyzed for meta-analysis using Cochrane ReviewManager software. Results Compared with dorsal plate, volar plate performed significantly better in Gartland and Werley score. Volar plating outperformed percutaneous pins for loss of reduction, infection, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and ulnar deviation. Loss of reduction, malunion, Patient Related Wrist Evaluation (PRWE) score, DASH score, grip strength, ulnar deviation, and supination were significantly better for volar plating when compared with casting. When compared with external fixation, volar plating had significantly less cases of infection, lower QuickDASH score, and higher range of motion for flexion, pronation, and supination. All other complication and functional outcomes were not significantly different. Conclusions Distal radius fractures treated with volar plating showed relatively better measures of complications, function scores, and range of motion than other treatment methods; however, there was no significant difference in healing time when compared with percutaneous pins. More studies are needed to compare the rest of the treatment methods with each other.

Keywords: casting; distal radial fracture; external fixation; percutaneous pins; volar or dorsal plate.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Study selection—flow diagram showing study selection process according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines.
Fig. 2
Fig. 2
Risk of bias—summary of the risk of bias assessment conducted with the Cochrane RoB2 tool.
Fig. 3
Fig. 3
Healing time and complications— forest plots showing ( A ) healing time (in weeks), ( B ) revision, ( C ) malunion, and ( D ) loss of reduction reported at final follow-up. CI, confidence interval; IV, intravenous.
Fig. 4
Fig. 4
Complications—forest plots showing ( A ) hardware failure and ( B ) infection reported by final follow-up. CI, confidence interval; IV, intravenous.
Fig. 5
Fig. 5
Other complications—forest plot showing total other complications reported at final follow-up. CI, confidence interval; IV, intravenous.
Fig. 6
Fig. 6
Function scores—forest plot showing ( A ) Patient Related Wrist Evaluation (PRWE) score and ( B ) Disabilities of the Arm, Shoulder, and Hand (DASH) score reported at final follow-up. CI, confidence interval; IV, intravenous; SD, standard deviation.
Fig. 7
Fig. 7
Function scores—forest plot showing ( A ) Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, ( B ) Gartland and Werley score, and ( C ) grip strength (as percent of uninjured hand) reported at final follow-up. CI, confidence interval; IV, intravenous; SD, standard deviation.
Fig. 8
Fig. 8
Range of motion—forest plot showing ( A ) flexion and ( B ) extension, measured in degrees, reported at final follow-up. CI, confidence interval; IV, intravenous; SD, standard deviation.
Fig. 9
Fig. 9
Range of motion—forest plot showing ( A ) radial deviation and ( B ) ulnar deviation, measured in degrees, reported at final follow-up. CI, confidence interval; IV, intravenous; SD, standard deviation.
Fig. 10
Fig. 10
Range of motion—forest plot showing ( A ) pronation and ( B ) supination, measured in degrees, reported at final follow-up. CI, confidence interval; IV, intravenous; SD, standard deviation.
Fig. 11
Fig. 11
Radiographic outcomes—forest plot showing ( A ) radial inclination (degrees) and ( B ) radial height (mm) reported at final follow-up. CI, confidence interval; IV, intravenous; SD, standard deviation.
Fig. 12
Fig. 12
Radiographic outcomes—forest plot showing ( A ) volar tilt (degrees) and ( B ) ulnar variance (mm) reported at final follow-up. CI, confidence interval; IV, intravenous; SD, standard deviation.
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References

    1. ÇİÇEKLİ Ö, ŞÜKÜR E, KOCHAİ A, BAYAM L, BİNGÖL İ, ÖZDEMİR U. Comparison of 2-year clinical and radiological outcomes between volar plating and external fixation with additional K-wires for AO Type C distal radius fractures. Turk J Med Sci. 2019;49(05):1418–1425. - PMC - PubMed
    1. Duramaz A, Bilgili M G, Karaali E, Bayram B, Ziroğlu N, Kural C. Volar locking plate versus K-wire-supported external fixation in the treatment of AO/ASIF type C distal radius fractures: A comparison of functional and radiological outcomes. Ulus Travma Acil Cerrahi Derg. 2018;24(03):255–262. - PubMed
    1. Jakubietz M G, Gruenert J G, Jakubietz R G. Palmar and dorsal fixed-angle plates in AO C-type fractures of the distal radius: is there an advantage of palmar plates in the long term? J Orthop Surg Res. 2012;7(01):8. - PMC - PubMed
    1. Roh Y H, Lee B K, Baek J R, Noh J H, Gong H S, Baek G H. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. J Hand Surg Am. 2015;40(01):34–41. - PubMed
    1. Rozental T D, Blazar P E, Franko O I, Chacko A T, Earp B E, Day C S. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am. 2009;91(08):1837–1846. - PubMed