Comparison of Locked Volar Plating Versus Pinning and External Fixation in the Treatment of Unstable Intraarticular Distal Radius Fractures

Abstract

Introduction We retrospectively compared the outcomes of open reduction and internal fixation (ORIF) with volar locking plate versus standard external fixation and percutaneous pinning in treating similar unstable distal radius fractures with a minimum 2-year follow-up. Methods The ORIF group included 41 patients with an average follow-up of 29 months. The external fixation group comprised 14 patients with an average follow-up of 33 months. Average age at presentation was 45 years in the external fixation group and 48 years in the ORIF group. The male/female ratios were 16:25 among the ORIF group and 6:8 in the external fixation group. The two groups were compared for clinical and functional outcomes measured by the disabilities of the arm, shoulder, and hand (DASH) score. Pain scores were similar. Radiographic measurements were also evaluated between groups. Results Final ranges of motion and grip strengths were similar between the two groups. The mean DASH score of the locked volar plate group was 9 compared to 23 for the external fixation group. Radiographically, volar tilt and radial length were significantly better in the patients treated with ORIF. The ORIF group required less therapy visits. No complications occurred in the locked volar plate group whereas two patients had pin tract infections and one had prolonged finger stiffness in the external fixation group. ConclusionLocked volar plating compares favorably to external fixation and pinning for amenable fracture patterns. Whereas grip and range-of-motion data were similar, DASH scores, frequency of rehabilitation, and some radiographic parameters were superior in patients treated with ORIF.

Intra articular distal radius fractures and volar plate fixation: a prospective study

“…They also concluded that volar locked plating is a boon for unstable fractures because of its stiffer construct and lower rates of complications. 20,21 No complications pertaining to extensor tendons was observed in this study. Similar conclusion was reached in separate studies by Hakim et al and Othman.…”

Functional and radiological outcome in distal radius fractures treated with locking compression plate

“…20 There is extensive work to show that locked volar plates are well tolerated, allow early movement and maintain position even for intraarticular fractures. 21,22 Proposed advantages of locked volar plating include improved pull out strength even in osteoporotic bone. 23 Internal fixation using a dorsal plate, which is greatly advocated, achieves anatomical reduction with good stability.…”

Functional outcome of fixation of unstable distal end radius fracture with volar buttress plating, A prospective study

“…Rizzo, B.A Katti, J.T. Carotheres [5] in their study had an average of 69 In this study functional outcome is graded using Modified Gartland & Werley [2] wrist grading system. In which excellent are 16.67%, good are 50%, fair are 23.33% and poor are 10%.…”