Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures

Abstract

The aim of this study is to compare the radiological and functional outcomes of open reduction and volar locking plates versus external fixation (EF) in the treatment of unstable intra-articular distal radius fractures. In this retrospective comparative study, 69 of 80 patients who underwent an operation for AO/ASIF C1, C2 and C3 distal radius fractures were assessed. Functional evaluation was performed using the Gartland-Werley scoring system and the PRWE scale, and wrist range of motion and grip strength was also measured. For the radiological assessment, radial inclination, volar tilt, radial length, ulnar variance, and articular step-off were compared. The range of movement was better for all parameters in the volar plate group, but only wrist flexion and pronation range differed significantly between the groups (p = 0.037 and p = 0.014, respectively). With the exception of better subjective functional results in the volar plate group, the differences were not significant. With respect to radiological evaluation, all parameters were better in the volar plate group, but only radial inclination and articular step-off were significantly better (p = 0.018 and p = 0.029, respectively). In the volar plate group, two patients had carpal tunnel syndrome and one patient had regional pain syndrome. In the external fixator group, six patients had superficial pin tract infection, two patients had sensory branch injury, and four patients had regional pain syndrome. Volar locking plate fixation appeared as a dependable method for the treatment of intra-articular distal radius, with lower complication rates. On the other hand, EF remains a suitable surgical alternative for these fractures, with easy application and acceptable results.

Surgical outcomes of elderly patients aged more than 80 years with distal radius fracture: comparison of external fixation and locking plate

“…A higher incidence of infection was noted in the EF group, in which 11/41 (27%) patients treated with EF developed a pin Significant p values are shown in bold tract infection that required oral antibiotic treatment versus 1/28 (4%) patients in the VLP group. The overall complication and infection rates of the EF group were higher in our study than in others [14,19,21,22]. Navarro et al [20] demonstrated that the total complication rate was equal between the EF and VLP groups.…”

Dorsal Bridge Plating versus External Fixation for Distal Radius Fractures

“…The higher infection rate is not unexpected, given that pin tract infections are one of the known disadvantages to ExFix and a primary limitation to time to hardware removal. [12][13][14][15][16][17] Despite the differences in complication rates in infection, hardware failure, and complex regional pain syndrome, there was no difference in unplanned reoperations between the two groups. The majority of pin tract infections can be successfully treated with antibiotics; ultimately, only two patients from the external fixator group required a secondary irrigation and debridement operation for infection.…”

Comparison of 2-year clinical and radiological outcomes between volar plating and external fixation with additional K-wires for AO Type C distal radius fractures

“…Higher rates of neuritis, implant failure, and infection have been recorded for EF, while tendon complications and early implant removal have been observed more frequently with VP in the studies by Jorge-Mora et al and Margaliot [24,26]. Leung et al found a lower rate of secondary osteoarthritis [27] and Kumbaraci et al [11] a lower complication rate overall in the VP group. However, similar total complication rates were reported by Navarro et al [21] and Shukla et al [17] for both methods.…”

“…Anatomic reduction and stable fixation of displaced intraarticular distal radius fractures are difficult to obtain, and poor outcomes are common [7][8][9][10]. Various surgical procedures have been described, but stabilization with a volar locking plate or an external fixator with additional K-wires are commonly used techniques [7,[10][11][12][13][14]. Although these two methods have been previously compared in the literature, their distinct advantages and disadvantages have not been clearly established so far [7,[11][12][13].…”