Type of fixation is not associated with range of motion after operative treatment of proximal radius fractures- a systematic review of 519 patients

Abstract

Background: The aims of this study are 1) to assess whether open reduction internal fixation (ORIF) techniques for fractures of the proximal radius are associated with the range of motion (ROM), 2) to determine the incidence of hardware-related complications and removal following plate and screw fixation of the proximal radius, and 3) to evaluate whether the safe-zone definition is described in the literature and its relation to the ROM.

Methods: A literature search was performed in the PubMed, Embase, and Cochrane databases. Studies reporting ROM in patients undergoing ORIF for radial head or neck fractures were included. Two treatment groups were defined based on ORIF technique: screws only or plates with and without additional screw placement.

Results: A total of 13 articles were included with 519 patients, of which 271 belonged to the screw group and 248 to the plate group. At final follow-up, the screw group reported a mean supination of 79 (95% CI: 74-83), pronation of 76 (95% CI: 69-84), flexion of 131 (95% CI: 124-138), and loss of extension of 4 (95% CI: 1-7). The plate group reported a mean supination of 72 (95% CI: 65-80), pronation of 697 (95% CI: 60-75), flexion of 126 (95% CI: 118-133), and loss of extension of 7 (95% CI: 1-14).

Conclusion: Predominantly retrospective studies show that the ROM seems similar for screw and plate osteosynthesis of proximal radius fractures. Complication rates are similar as well. The safe-zone definition is rarely reported.

Keywords: Fracture fixation; ORIF; Postoperative complications; Proximal radius fractures; Range of motion; Revision surgery; Safe zone definition.

Figure 1

Selection progress flowchart.

Figure 2

Fracture types categorized based on the Mason classification^, and segmented into plate and screw groups, presented as percentages.

Figure 3

Forest plots demonstrating outcomes per study, divided in groups, for postoperative supination (A), pronation (B), flexion (C), and loss of extension (D). Heterogeneity is depicted by I² per subgroup. Number, size of the study population, Mean, mean range of motion, SD, standard deviation, 95%CI, 95% confidence interval, I², level of heterogeneity. a, conventional cortical screw group, b, headless compression screw group, c, novel group, d, conventional group, e, novel group, f, conventional group. The significant variability, potentially influenced by variying study sample sizes and subjectivity of outcome measures, should be taken into account when interpreting the overall findings.

Figure 4

Image depicting described safe zones for the anterolateral aspect (Yellow: Esser et al & Li et al²⁹), posterolateral aspect (Green: Guo et al & Yang et al⁵⁶) and combined aspect (Blue: Ma et al³⁰) of the radial head and neck. A, Anteriorl; L, Lateral; P, Posterior; M, Medial.