Comparison of outcome of extra articular lower end radius fracture with percutaneous pinning and volar locking plate

Abstract

INTRODUCTIONFractures of the distal radius are common fractures seen in orthopedics outpatient and trauma care. Data suggests that around 6% of women by age of 80 years will sustain such fracture and 9% women by age of 90.1 As the population continues to age, these figures are likely to increase still further. Its growing incidence may be attributed to a parallel rise of osteoporosis and high energy accidents.2,3 The epidemiology has changed from the times of Colle's fracture to present date due to increased life expectancy and increased in high energy trauma. Various authors have stated the age specific incidence, that ranged from 9 to 100 per 10,000 per year. [4][5][6] Various operative and non-operative treatment options are available, without there being a consensus as to an optimal method according to the patients demographics and fracture pattern. 7,8 Despite this being a topic of discussion there have been very few studies focusing on the functional outcomes following percutaneous K wiring and volar plating in extra articular fractures. Each having their own merits and demerits.Percutaneous wire fixation being a relatively quick and minimally invasive procedure that could be carried out in limited operative environment. However, since the ABSTRACT Background: As fractures of the distal radius are the most common fractures of the upper extremity with no clear guidelines for mode of intervention it was decided to compare two of the most common methods of treatment. The aim of this study was to review a group of patients sustaining extra articular lower end radius fracture treated with percutaneous wiring and volar plating and compare their functional outcome at a significant follow up time. Methods: A prospective study was conducted at tertiary care center. A sample of 45 patients who had a displaced extra articular distal radius fracture and were subjected to treatment with either a plate (n =24) or k wiring (n =21). Outcome assessments were conducted at 6 months. Outcomes were measured on the basis of scores on the DASH questionnaire, wrist range of motion, and radiographic parameters. Results: Patients in the plate group had significantly better DASH scores (p=0.0431) and range of motion at six months compared with patients in the k wiring group. Collapse in radial length was observed in 2 patients with percutaneous wiring which led to suboptimal range of motion and increased DASH scores. Significance arc of motion at 6months in dorsiflexion and palmar flexion were p=0.0038 and when compared with opposite limb were significant in all three planes p=0.0217, p=0.0126 and p=0.0029. Conclusions: Based on our observation we found that treatment of dorsally displaced, unstable extra articular radius fractures across all age groups, volar-locked plates achieve a superior radiological and functional outcome with minimal complications.

Management of distal radius fractures in the emergency department: A long‐term functional outcome measure study with the Disabilities of Arm, Shoulder and Hand (DASH) scores

“…Multiple linear regression (MLR) models were adopted for multivariate analysis of the DASH scores to identify the significant predictor variables. From the literature, we found that age, sex, ethnicity, type of fractures, clinicians involved, type of anaesthetic techniques and POP used affected the outcome of DRF. Therefore, we took those variables into consideration during developing MLR models.…”

“…In our study, ‘group’ was our variable of interest. In addition, we have considered age, sex, ethnicity, type of fractures, clinicians involved, type of anaesthetic techniques and POP used as confounders and potential predictor variables. To make it clinically meaningful, continuous variables such as the age of the patients were centred .…”

“…11 The DASH is a validated tool to measure outcomes of upper limb injuries, including DRF. 4,[12][13][14][15][16] Although there are other techniques of outcome measures following DRF management such as Patient Reported Wrist Evaluation (PRWE), it has been reported that there is a strong correlation between DASH and PRWE scores. 16 Some authors used pain scores to assess the outcome of DRF.…”

“…Jagdev et al showed that DASH scores were higher among the patients who were treated with kwires in comparison to volar plates. 15 Although k-wires do not constitute conservative management, it showed similar issues such as the collapse of fracture fragments, which led to higher complications and poorer functional outcomes. However, our study contradicts the study of Jagdev et al 15 as we found that DASH score was higher in the ORIF group.…”

Prospective Randomized Study Comparing the External Fixator and Volar Locking Plate in Intraarticular Distal Radius Fractures: Which Is Better?

“…Arthroscopic-assisted reduction during external fixation enhances the ability to achieve satisfactory reduction due to the direct visualization of the joint surface and concomitant assessment of the wrist ligaments. In recent times, with the advent of lower-profile polyaxial locking screw implants, it has become easier to address fractures with extensive fragmentation, variations in normal anatomy, and dorsal metaphyseal instability with a single surface implant leading to the increased popularity of the open reduction and internal fixation of these fractures among surgeons [11][12].…”