Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires

Abstract

BackgroundDorsally displaced distal radius fractures (DDDRF) are frequent injuries in clinical practice. Traditional percutaneous Kirschner wires (K-wire) and open reduction with volar locking plate (VLP) are the two most common surgical fixation techniques used to manage DDDRF. However, there is no current consensual evidence to guide the selection of one technique over the other. Therefore, we undertook a systematic search and meta-analysis to compare clinical outcomes and complications of these two treatment approaches for DDDRF.MethodsThe following electronic databases were searched by two independent reviewers, up to April 2015: PubMed, ScienceDirect and Wiley Online Library. High-quality randomized controlled trials (RCTs) comparing VLP and percutaneous K-wire fixation for DDDRF were identified. Pooled mean differences were calculated for the following continuous outcome variables: disabilities of the arm, shoulder and hand (DASH) score, grip strength and wrist range of motion. Pooled odds ratios were calculated for rates of total postoperative complications, including superficial infection, deep infection, complex regional pain syndrome (CRPS), carpal tunnel syndrome (CTS), neurological injury, tendon rupture, tenosynovitis, loss of reduction and additional surgery to remove hardware. The meta-analysis was completed using RevMan 5.3 software.ResultsSeven RCTs, with a total of 875 patients, were included in our meta-analysis. Open reduction internal fixation (ORIF) with VLP fixation provided statistically lower DASH scores, reduced the incidence of total postoperative complications and specifically lowered the rate of superficial infection, when compared, over a 1-year follow-up, to percutaneous K-wire fixation. VLP fixation also provided significantly better grip strength and range of wrist flexion and supination in the early 6-month postoperative period, compared with percutaneous K-wire fixation.ConclusionORIF with VLP fixation provided lower DASH scores and reduced total postoperative complications, most specifically lowering the risk for postoperative superficial infection compared to K-wire fixation over a 1-year follow-up period. However, superficial pin track infections do not cause clinical debility in the vast majority of cases. Thus, the claim of reduced superficial infection rate may not be clinically important. The only reasonable conclusion that can be drawn is that at present, there is insufficient data even on our meta-analysis to help the clinician make an informed choice.

Volar locking plating versus percutaneous Kirschner wires for distal radius fractures in an adult population: a meta‐analysis

“…These findings are similar to those identified in recent reviews . These analyses found a slight functional advantage in the early post‐operative period for VLP.…”

“…These findings are similar to those identified in recent reviews. [27][28][29]32 These analyses found a slight functional advantage in the early post-operative period for VLP. At 12 months, the difference in function was thought to be imperceptible to patients.…”

“…There have been several trials comparing the two fixation methods with variable results regarding functional outcomes, range of motion (ROM), radiological outcomes and complications . Recently published meta‐analyses have identified equivocal results . The selection criteria of this analysis differ from the aforementioned studies by excluding studies of elderly patients exclusively (>65), as well as those with a follow‐up period of less than 12 months.…”

“…4,7,8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Recently published meta-analyses have identified equivocal results. [27][28][29][30][31][32] The selection criteria of this analysis differ from the aforementioned studies by excluding studies of elderly patients exclusively (>65), as well as those with a follow-up period of less than 12 months.…”

Biomechanical Comparison of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer-Bioresorbable Balloon Osteosynthesis and a Volar Locking Plate for Treatment of Distal Radius Fractures

“…The most widely used modality is a VLP system [10] to the extent that some refer to it as the "treatment of choice" [11] [12]. There is a large volume of literature on clinical performance (functional scores and radiological outcomes) of many modalities, either on their own or in comparison with one or more of others [13]- [19]. This has led to identification and discussion of shortcomings and complications of many modalities [17].…”