Comparison of Intramedullary Nail and Volar Locking Plate for Distal Radius Fractures: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Abstract

Operative intervention with a volar locking plate (VLP) is currently the gold standard for the fixation of distal radius fractures. Intramedullary nailing (IMN) of the distal radius is a novel technique that aims to reduce soft tissue complications due to a smaller surgical incision while maintaining the benefits of a rigid fracture fixation. The aim of this systematic review and meta-analysis was to investigate the functional, clinical, and radiological outcomes of all published randomised controlled trials (RCTs) comparing patient outcomes of VLP and IMN in distal radius fracture fixation. Three databases (Ovid MEDLINE, EMBASE, and Cochrane Library) were searched in July 2021. The inclusion criteria were RCTs comparing fixation of extra-articular or simple intra-articular distal radius with VLP or IMN and availability of full text in English. Children under the age of 18 were excluded. Seven trials with a total of 398 patients were included in this meta-analysis. The meta-analysis showed that there were improved short-term clinical outcomes favouring IMN, although there were no significant differences in terms of functional, radiological, and long-term clinical outcomes. Analysis showed that outcomes of IMN are comparable with VLP for fixation of extra-articular and simple intra-articular distal radius fractures. However, these results should be interpreted with caution due to the small sample size. We recommend that further high-quality trials are required to establish the role of IMN in distal radius fixation.

Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials

“…Some surgical modality treatments, such as intramedullary nails, have been used for the stabilization of unstable DFRs, with the aim of reducing soft tissue complications due to a smaller surgical incision while maintaining the benefits of rigid fracture fixation [ 57 , 58 ]. On the other hand, a dorsal plate was used with the aim of allowing the most direct exposure and reconstruction of the joint by a capsular incision but required dissection of the extensor retinaculum and subsequent plate positioning beneath this tendon, which often led to tendonitis or tendon rupture [ 59 ].…”

Intramedullary Plate Fixation and Viable Bone Allografting in a Complex Intra-articular Distal Radius Fracture Nonunion: A Case Report

“…They occur in a bimodal distribution, usually involving those younger than 18 years or older than 50 with osteopenia or osteoporosis [2]. The gold standard for management is volar locking plate fixation with fragment-specific treatment indicated when the articular surface is severely comminuted [3][4][5]. As an alternative, bridge plating involving temporary placement of a dorsal spanning plate (DSP) has been favorably described for maintaining radial length, distracting the articular surface, and providing rigid stabilization to prevent articular surface loading [6,7].…”