Comparison of volar plate screw fixation with k-wire fixation by closed technique in instable distal radius fractures

The aim of the present study was to compare the clinical outcomes of volar plate screw fixation with the K-wire fixation with external fixator applied with closed technique in instable distal radius fractures extending to the joint in elderly patients. The study included 60 patients who were treated for AO type C distal radius fracture in our clinic between January 2016 and January 2019. The patients were divided into two groups: Group External fixator (EF) with 30 patients who underwent multiple K-wires using closed technique and Group Volar Plate (VP) with 30 patients who underwent volar plate and screw fixation using open technique. Wrist range of motion (ROM), disabilities of the arm, shoulder and hand (DASH) score and grip strength values, radiologic parameters were compared between groups. After 12 months of follow-up, there was no significant difference in DASH score and grip strength values between the two groups (p = 0.263 and 0.085, respectively). The mean duration of surgery was found to be shorter in the EF group (p < 0.001). There was no significant difference between radiologic parameters. Significantly fewer fluoroscopy applications were needed in the VP group than in the EF group (p < 0.001). Both VP and EF treatments had similar functional outcomes in patients over 65 years of age. Considering its shorter duration of surgery and less invasive nature, EF treatment was concluded to be more applicable in patients over 65 years of age.

PDF

___

1. O’Neill TW, Cooper C, Finn JD, et al. Incidence of distal forearm fracture in British men and women. Osteoporosis Inter. 2001;12:555-8.
2. Koca K, Erşen Ö, Akpancar S, et al. Demographic features of patients with extremity and spine fractures in emergency departments. Eurasian Emergency Med. 2017;16:19.
3. Gül D, Akpancar, S. Fractures in Geriatric Cases. J Geriatric Science. 2019;2:14-9.
4. Roh YH, Lee BK, Baek JR, et al. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. J Hand Surgery Am. 2015;40:34-41.
5. Ermutlu C, Mert M, Kovalak E, et al. Management of distal radius fractures: comparison of three methods. Cureus. 2020;12:e9875.
6. Konrads C, Gonser C, Bahrs C. Frakturen des distalen Radius Fractures of the Distal Radius. Z Orthop Unfall. 2021;159:217-31.
7. Patiño JM, Rullan Corna AF, Michelini A, Abdon I. Distal radius fractures - Treatment with volar locking plates - Functional results according to fracture type. Rev Fac Cien Med Univ Nac Cordoba. 2020;77:272-5.
8. Orbay JL, Touhami A. Current concepts in volar fixed angle fixation of unstable distal radius fractures. Clinical Orthopaedics and Related Res. 2006;445:58-67.
9. Chaudhry H, Kleinlugtenbelt YV, Mundi R, et al. Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A metaanalysis. Clin Orthopaedics Related Res. 2015;473:3017-27.
10. Kural C, Sungur I, Kaya I, et al. Evaluation of the reliability of classification systems used for distal Radius fractures. Orthopedics. 2010;33:801.
11. Shukla R, Jain RK, Sharma NK, Kumar R. External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes. J Orthopaedics Traumatol. 2014;15:265-70.
12. Jeudy J, Steiger V, Boyer P, tet al. Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation ‘versus’ locked volar plating. 2012;43:174-9.
13. Grewal R, MacDermid JC, King GJ, Faber KJ. Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg Am. 2011;36:1899-906.
14. Kumbaraci M, Kucuk L, Karapinar L, et al. Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures. Eur J Orthopaedic Surg Traumatol. 2014;24:173-8.
15. Çiçekli Ö, Şükür E, Kochai A, et al. 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. Turkish J Med Science. 2019;49:1418-25.
16. Arslan AK, Yaşar Ş, Çolak C, Yoloğlu S. WSSPAS: an interactive web application for sample size and power analysis with R using shiny. Turkiye Klinikleri J Biostatistics. 2018;10:224-46..