A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures

Abstract

Purpose Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment. This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation. Methods A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups: volar plate group and external fixator group. These patients aged between 18 and 60 years had unilateral fractures, and agreed to be included in the study. Patients with a history of fracture, bilateral fracture, associated other injuries, delayed injury for more than 2 weeks, open fracture, pre-existing arthrosis or disability, psychiatric illness and pathological fracture were excluded. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The assessment of pain, functional activity, range of motion and grip strength was done at each stage of follow-up. The pain and functional activities were assessed by patient rated wrist evaluation (PRWE) score and disabilities of the arm, shoulder and hand (DASH) score. Results Patients in volar plate group had superior PRWE score and DASH score at each stage of follow-up. At 1 year follow-up, the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group; while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group. They had better flexion and extension range of movement. They also had better pronation and supination range of motion at initial follow-up, however the difference get attenuated by 1 year. Volar plate group had significantly better grip strength than external fixator group. Complication rates were higher in external fixation group. Conclusion Fixation with variable angle volar plate results in early wrist mobilization, better range of movement, less pain and disability and early return of function.

Comparison between Volar Locking Plate and Kirschner Wire Fixation for Unstable Distal Radius Fracture: A Meta-Analysis of Randomized Controlled Trials

“…Finally, and most importantly, the inclusion criteria among the 14 trials were heterogenous in terms fracture type. Five trials did not report on the fracture type, while study by Mishra et al 36 exclusively reported on AO type C fracture, whereas McFadyen et al 28 exclusively reported on AO type A and rest of the studies reported data on both type A and C fractures. Such heterogeneous distribution of fracture types raises valid concerns on the validity and applicability of our meta-analysis.…”

“…Of the 14 studies, 3 were conducted in the United States, 3 conducted in the United Kingdom, and 1 study each from France, Belgium, Germany, Columbia, Iran, Pakistan, and India. [14][15][16][26][27][28][29][30][31][32][33][34][35][36] There was only one multicenter trial that was conducted in the United States, Canada, and Singapore. The sample size per study ranged from 34 to 461 participants including 352 males and 478 females.…”

Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern?

“…Nevertheless, to the best of our knowledge, this is the first single-centre study reporting functional clinical outcomes of DRFs at medium-term follow-up and including beta multivariate regression analysis on a large patient cohort compared to previous published studies on the same topic [12,46,[68][69][70]. Further, all patients enrolled were operated on by the same trauma surgeons and followed according to a standardised institutional postoperative protocol, reducing confounding bias.…”