Volar Locking Plates Versus Augmented External Fixation of Intra-Articular Distal Radial Fractures

Abstract

Background: The aim of the study was to compare the functional outcomes following fixation with a volar locking plate (VLP) with those outcomes after augmented external fixation (EF) of displaced, intra-articular distal radial fractures in patients 18 to 70 years of age. Methods: Following inclusion, randomization, and surgery, clinical examination and outcome assessments were conducted at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years. The primary outcome was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and secondary outcomes included wrist range of motion, grip strength, and pain assessed with a visual analog scale (VAS). Results: Over a span of 3 years, 166 patients were included in the study. The mean age was 55.0 years (standard deviation [SD] = 11.5 years), with the ages distributed evenly in each treatment group by block randomization (84 patients in the VLP group and 82 in the EF group). The patients in the VLP group had a significantly better mean QuickDASH score, range of motion, and grip strength at 6 weeks, 12 weeks, 6 months, and 1 year. There were no significant differences between the groups at 2 years. On the basis of the minimal clinically important difference, the difference in the QuickDASH score was clinically relevant only at 6 weeks and arguably at 3 months (9.2 and 8.5 points, respectively). Therefore, the statistically significant improvement in the functional outcome of VLP compared with that of EF cannot be safely said to have clinical relevance beyond 12 weeks. The overall complication rate was comparable between the 2 groups. The rate of follow-up at 2 years was 97.0%. Conclusions: VLP fixation resulted in faster recovery of function compared with EF, but no functional advantage was demonstrated at 2 years. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

A retrospective analysis comparing functional and radiological outcomes after treatment of unstable distal radius fractures using volar locked plate versus percutaneous fixation

“…This study demonstrates that a good radiological and clinical outcome can be achieved in both groups with no difference in either ROM or validated patient related outcome scores like QuickDASH which was similarly reflected in other studies. 15 However hammer et al and other studies showed significant difference in QuickDASH scores in their report at 1year follow-up which contradicts our result. 15,30,31 The radiological outcome after 01 year follow up shows better maintenance of palmar tilt, radial length and inclination in VLP group which is substantiated by other studies.…”

“…15 However hammer et al and other studies showed significant difference in QuickDASH scores in their report at 1year follow-up which contradicts our result. 15,30,31 The radiological outcome after 01 year follow up shows better maintenance of palmar tilt, radial length and inclination in VLP group which is substantiated by other studies.…”

“…Our study shows major complication rate of 12.2% (15/122) and a minor complication rate 17.21% (21/122) which is comparable to other recent reports in the literature (Table 5). 7,15,30 Clearly not every fracture of the distal radius should be operated on; a decision must be taken based on the degree of displacement or deformity and the functional level of the patient. This study demonstrates that a good radiological and clinical outcome can be achieved in both groups with no difference in either ROM or validated patient related outcome scores like QuickDASH which was similarly reflected in other studies.…”

“…There was no significant difference in the number of satisfactory reductions in both groups (p=0.089). 15,16 After analysis of X rays at immediate post-op and 1 year follow up it was noted that there was a significant difference between the two groups with regards to maintenance of reduction. The VLP group in comparison had better radial length (p=0.04), volar tilt (p=0.03) and radial inclination (p=0.03) at the most recent follow-up (Table 2).…”

Early Mobilization and Physiotherapy Vs. Late Mobilization and Home Exercises After ORIF of Distal Radial Fractures

“…Volar locking plates have shifted the treatment of displaced distal radial fractures (DRFs) from previous methods such as percutaneous pinning and external fixation to plate fixation 1-4 . The volar locking plate permits early mobilization, omitting the need for prolonged cast immobilization.…”