Volar locking plate vs cast immobilization for distal radius fractures: a systematic review and meta-analysis

Abstract

Introduction The aim of this systematic review and meta-analysis was to evaluate whether volar locking plate (VLP) fixation leads to better clinical and radiological outcomes than those of closed reduction and cast immobilization for the treatment of distal radius fractures (DRFs). Materials and methods A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane databases up to January 2022. Inclusion criteria included randomized controlled trial (RCT) studies comparing VLP fixation with cast immobilization for DRFs. Investigated parameters were Patient-Rated Wrist Evaluation questionnaire, Disabilities of the Harm, Shoulder, and Hand score (DASH), range of motion (ROM), grip strength, quality of life (QoL), radiological outcome, and complication and reoperation rate, both at short- and mid-/long-term follow-up. Assessment of risk of bias and quality of evidence was performed with Downs and Black’s ‘Checklist for Measuring Quality’. Results A total of 12 RCTs (1368 patients) were included. No difference was found for ROM, grip strength, QoL, and reoperation, while the DASH at 3 months was statistically better in the VLP group (P < 0.05). No clinical differences were confirmed at longer follow-up. From a radiological perspective, only radial inclination (4°) and ulnar variance (mean difference 1.1 mm) at >3 months reached statistical significance in favor of the VLP group (both P < 0.05). Fewer complications were found in the VLP group (P < 0.05), but they did not result in different reintervention rates. Conclusions This meta-analysis showed that the surgical approach leads to a better clinical outcome in the first months, better fracture alignment, and lower complication rate. However, no differences in the clinical outcomes have been confirmed after 3 months. Overall, these findings suggest operative treatment for people with higher functional demand requiring a faster recovery, while they support the benefit of a more conservative approach in less demanding patients.

Complications after volar plate synthesis for distal radius fractures

“…Regarding the complication types, this review demonstrates that CTS is the most common complication after volar locking plate fixation, with a rate of 2.0%, thus accounting for 14.3% of all complications. CTS is quite frequent in the general population, especially in middle-aged women and manual workers ( 127 ), but it is also known to occur as a product of distal radius fractures in 7–15% of cases, regardless of the treatment strategy ( 128 ). Generally, it is believed that CTS following distal radius fracture is not directly related to the hardware, but rather to the trauma suffered by the nerve due to the fracture and/or subsequent healing with thickening of the bony anatomy, residual malunion, and traction of the median nerve by the flexor pollicis longus (FPL) tendon.…”

“…Pain or hardware discomfort is not always experienced by the patient, who nevertheless wants to proceed with plate removal because of the belief that they have ‘foreign’ material in the body. In addition, sometimes the patient’s request for plate removal may be due to the fact that the clinical result is inferior to what was hoped for, with the patient willing to remove the plate in the hope of gaining functional improvement ( 126 , 128 ).…”

Duration of sick leave after operated and non-operated distal radial fracture: a Finnish cohort study of 19,995 patients

“…Our results are not in line with the findings of earlier publications reporting the functional results of different treatment options for DRF. Several recent meta-analyses have shown that operative treatment may result in better functional outcomes in working age patients at 3 months when compared with non-operative treatment ( Linnanmäki et al., 2023 ; Ochen et al., 2020 ; Oldrini et al., 2022 ). It is often argued that the lack of long-term benefits should be considered when choosing between operative and non-operative treatment of DRF.…”

Factors Associated with Re‐Displacement after Nonsurgical Treatment of Distal Radius Fractures in Adults: A Retrospective Study

“…At the 12‐month follow‐up, surgical treatment demonstrated an advantage solely in EQ‐5D‐5L scores, with no notable differences in wrist joint range of motion, Quick DASH scores, or complications. 25 Furthermore, the meta‐analysis led by Oldrini et al 26 indicated that, in comparison to conservative treatment, surgical intervention for distal radius fractures exhibited superior clinical outcomes only within the initial 3 months, with no significant differences in clinical outcomes during long‐term follow‐ups. Similarly, the meta‐analysis by Ochen et al 27 disclosed that surgical intervention showed an advantage over nonsurgical methods in terms of mid‐term DASH scores, but no significant difference in the overall incidence of complications.…”