Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial

McFadyen, I.; Field, J.; McCann, P.A.; Ward, Jessica; Nicol, S.; Curwen, C.

doi:10.1016/j.injury.2010.07.236

Cited by 78 publications

(52 citation statements)

References 44 publications

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“…However, dorsal plating is supposedly associated with soft tissue problems including adherence of the overlying soft tissues, tendon irritation, and rupture [21]. Compared with dorsal and radial plates, volar plates are associated with fewer soft tissue complications and have become increasingly popular over recent years, especially since the introduction of volar locking plates [16,[25][26][27][28][29]. More important than whether one uses a volar or dorsal approach is the three-column concept.…”

Section: Discussionmentioning

confidence: 99%

Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era

Twigt

Bemelman

Lansink

et al. 2013

International Orthopaedics (SICOT)

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Purpose C-type distal radial fractures remain challenging fractures. Currently locking plates are very popular because of their length preserving, stability. A considerable drawback is the high cost. Since 2003 we have been using mini AO plates (2.7 mm) as an alternative. We analysed our results and performed a cost analysis. Methods Retrospective analysis was performed of all patients operated upon between 2003 and 2008 for C type distal radius fractures. Reduction was achieved with mini AO plates, applied in a buttress fashion, with ligamentotaxis. Rehabilitation consisted of immediate mobilisation. Pre-and postoperative X-rays, operative results and patient charts were reviewed. Furthermore, we prospectively evaluated the functional results using VAS, DASH and Mayo wrist scores. Lastly, we assessed the implant costs and compared them to locking plates. Results Thirty-four patients were treated with a mean age of 49 years. Mean radial shortening improved 2 mm; dorsal and radial angulation improved 23 and 4°, respectively. At consolidation (eight weeks) the average radial shortening was 0.75 mm, a volar angulation of 3°, and 21°of radial angulation. Functional results were excellent, demonstrated by a mean VAS score less than 1, a DASH score of 12 and a Mayo wrist score of 87. Compared to locking plates, there was an overall reduction in material costs of 15,300 Euro.Conclusions Our technique has excellent biomechanical stability, enabling immediate functional rehabilitation, good anatomical and functional outcome with significantly lower costs.

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Section: Discussionmentioning

confidence: 99%

Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era

Twigt

Bemelman

Lansink

et al. 2013

International Orthopaedics (SICOT)

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“…Among trials that reported sufficient information for metaanalysis, there were no differences in volar tilt (four trials, 0.1°greater in K-wire group; 95% CI, À4.6°to 4.9°; p = 0.96), radial inclination (four trials, 0.4°greater in Kwire group; 95% CI, À0.9°to 1.7°; p = 0.58), or radial height (three trials, 0.4 mm greater in K-wire group; 95% CI, À0.3 mm to 1.0 mm; p = 0.31) at final followup. Of the two trials that could not be included in meta-analysis, one reported better volar tilt, radial height, and radial inclination with the volar locking plate but did not report absolute values [30]; the other trial reported a greater median volar tilt in the K-wire group (4°vs 0°in volar locking plate group) but did not provide any data to estimate variance (eg, SD, interquartile range) or statistically analyze the data. Only one study reported articular step-off postoperatively [21], and it detected no difference between the two interventions.…”

Section: Functional Outcomesmentioning

confidence: 99%

“…According to US Medicare data, internal fixation is the most common surgical intervention for distal radius fracture in the United States, followed closely by percutaneous pinning with K-wires [3]. To our knowledge, there have been no meta-analyses comparing these two common interventions despite multiple trials on the topic having been published [5,12,18,21,29,30,37].…”

Section: Introductionmentioning

confidence: 99%

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Chaudhry

Kleinlugtenbelt

Mundi

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Distal radius fractures are common, costly, and increasing in incidence. Percutaneous K-wire fixation and volar locking plates are two of the most commonly used surgical treatments for unstable dorsally displaced distal radius fractures. However, there is uncertainty regarding which of these treatments is superior. Questions/purposes We performed a meta-analysis of randomized controlled trials to determine whether patients treated with volar locking plates (1) achieved better function (2) attained better wrist motion, (3) had better radiographic outcomes, and (4) had fewer complications develop than did patients treated with K-wires for dorsally displaced distal radius fractures. Methods We performed a comprehensive search of MEDLINE (inception to 2014, October Week 2), EMBASE (inception to 2014, Week 42), and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials; we supplemented these searches with manual searches. We included studies of extraarticular and intraarticular distal radius fractures. Adjunctive external fixation was acceptable as long as the intent was to use only K-wires where possible and external fixation was used in less than 25% of the procedures. We considered a difference in the DASH scores of 10 as the minimal clinically important difference. We performed quality assessment with the Cochrane Risk of Bias tool and evaluated the strength of recommendations using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Seven randomized trials with a total of 875 participants were included in the meta-analysis. Results Patients treated with volar locking plates had slightly better function than did patients treated with K-wires as measured by their DASH scores at 3 months (mean difference [MD], 7.5; 95% CI, 4.4-10.6; p \ 0.001) and 12 months (MD, 3.8; 95% CI, 1.2-6.3; p = 0.004). Neither of these differences exceeded the a priori-determined threshold for clinical importance (10 points). There was a small early advantage in flexion and supination in the volar locking plate group (3.7°[95% CI, 0.3°-7.1°; p = 0.04] and 4.1°[95% CI, 0.6°-7.

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“…16 Two other retrospective reports exist, directly comparing fixation with volar-locked plates and percutaneous pinning but their comparison included both extra as well as intra articular fractures. Oshige et al examined dorsally angulated displaced fractures in 62 patients in a nonrandomised cohort of elderly patients.…”

mentioning

confidence: 99%

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

et al. 2017

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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.

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Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial

Cited by 78 publications

References 44 publications

Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era

Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

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

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