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

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

Background/aim: Surgical treatment of distal intraarticular radius fractures remains controversial. Our aim was to compare the clinicaland radiological outcomes between volar plating (VP) and external fixation (EF) for distal intraarticular radius fractures two yearspostoperatively.Materials and methods: This retrospective study included 59 patients with 62 intraarticular AO Type C distal radius fractures. Wedistinguished two groups: patients treated with internal fixation (volar locking plate, VP group: 41 fractures), and patients treated withan external fixator and K-wires (EF group: 21 fractures). The clinical assessment included range of motion, grip strength, disability of thearm, shoulder, and hand (DASH), and visual analog scale scores. Radiological measurements comprised flexion and extension, radialvolar tilt, inclination, height, shortening, and ulnar variance.Results: Postoperative grip strength and flexion angles were better after VP (P = 0.004, P = 0.009), but there was no difference in DASHscores (P = 0.341). Radial inclination was significantly different compared to that of the uninjured hand after VP (P = 0.0183), but notEF (P = 0.11).Conclusion: VP and EF result in similar clinical and radiological outcomes after 2 years. Function is not restored to the functionalityof the contralateral and noninjured hand.

___

  • 1. Dario P, Matteo G, Carolina C, Marco G, Cristina D et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury 2014; 45(Supplement 6): 21-26.
  • 2. O’Neill TW, Cooper C, Finn JD, Lunt M, Purdie D et al. Incidence of distal forearm fracture in British men and women. Osteoporosis International 2001; 12(7): 555-558.
  • 3. Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 150,000 adults: the influence of age and gender. Journal of Bone and Joint Surgery, British Volume 1998; 80(2): 243-248.
  • 4. Kopylov P, Johnell O, Redlund-Johnell L, Bengner U. Fractures of the distal end of the radius in young adults: a 30-year followup. Journal of Hand Surgery, British Volume 1993; 18(1): 45- 49.
  • 5. Melton LJ III, Amadio PC, Crowson CS, O’Fallon WM. Long-term trends in the incidence of distal forearm fractures. Osteoporosis International 1998; 8(4): 341-348.
  • 6. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clinics 2012; 28(2): 113-125.
  • 7. Roh YH, Lee BK, Baek JR, Noh JH, Gong HS et al. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. Journal of Hand Surgery, American Volume 2015; 40(1): 34-41.
  • 8. Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC et al. Treatment of unstable distal radial fractures with the volar locking plating system. Journal of Bone and Joint Surgery, American Volume 2006; 88(12): 2687-2694.
  • 9. Orbay JL, Touhami A. Current concepts in volar fixedangle fixation of unstable distal radius fractures. Clinical Orthopaedics and Related Research 2006; 445: 58-67.
  • 10. Mignemi ME, Byram IR, Wolfe CC, Fan KH, Koehler EA et al. Radiographic outcomes of volar locked plating for distal radius fractures. Journal of Hand Surgery, American Volume 2013; 38(1): 40-48.
  • 11. Kumbaraci M, Kucuk L, Karapinar L, Kurt C, Coskunol E. Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures. European Journal of Orthopaedic Surgery and Traumatology 2014; 24(2): 173-178.
  • 12. Jeudy J, Steiger V, Boyer P, Cronier P, Bizot P et al. Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation ‘versus’ locked volar plating. Injury 2012; 43(2): 174-179.
  • 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. Journal of Hand Surgery, American Volume 2011; 36(12): 1899-1906.
  • 14. Chaudhry H, Kleinlugtenbelt YV, Mundi R, Ristevski B, Goslings JC et al. Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A metaanalysis. Clinical Orthopaedics and Related Research 2015; 473(9): 3017-3027.
  • 15. Kural C, Sungur I, Kaya I, Ugras A, Erturk A et al. Evaluation of the reliability of classification systems used for distal radius fractures. Orthopedics 2010; 33(11): 801.
  • 16. Zumsteg JW, Molina CS, Lee DH, Pappas ND. Factors influencing infection rates after open fractures of the radius and/or ulna. Journal of Hand Surgery, American Volume 2014; 39(5): 956-961.
  • 17. 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. Journal of Orthopaedics and Traumatology 2014; 15(4): 265-270.
  • 18. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. Journal of Bone and Joint Surgery, American Volume 1986; 68(5): 647-659.
  • 19. Abe Y, Suzuki M, Wakita H. Dual plating technique for volar rim fracture of the distal radius using DePuy-Synthes 2.0 mm and 2.4 mm locking plates. Journal of Hand Surgery, AsianPacific Volume 2017; 22(4): 423-428.
  • 20. Suojärvi N, Sillat T, Lindfors N, Koskinen SK. Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images. Skeletal Radiology 2015; 44(12): 1769-1775.
  • 21. Mellstrand Navarro C, Ahrengart L, Törnqvist H, Ponzer S. Volar locking plate or external fixation with optional addition of K-wires for dorsally displaced distal radius fractures: a randomized controlled study. Journal of Orthopaedic Trauma 2016; 30(4): 217-224.
  • 22. Drobetz H, Koval L, Weninger P, Luscombe R, Jeffries P et al. Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial. World Journal of Orthopaedics 2016; 7(10): 687-694.
  • 23. Khatri K, Sharma V, Farooque K, Tiwari V. Surgical treatment of unstable distal radius fractures with a volar variable-angle locking plate: clinical and radiological outcomes. Archives of Trauma Research 2016; 5(2): e25174.
  • 24. Jorge-Mora AA, Cecilia-López D, Rodríguez-Vega V, SuárezArias L, Andrés-Esteban E et al. Comparison between external fixators and fixed-angle volar-locking plates in the treatment of distal radius fractures. Journal of Hand and Microsurgery 2012; 4(2): 50-54.
  • 25. Şenel A, Öztürkmen Y, Akman YE, Şükür E, Ünar EA. Clinical and Radiologic Outcomes of Volar Plate Fixation in AO Type C distal radius fractures. İstanbul Medical Journal 2018; 19(2): 119-123.
  • 26. Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC. A metaanalysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. Journal of Hand Surgery, American Volume 2005; 30(6): 1185-1199.
  • 27. Leung F, Tu YK, Chew WY, Chow SP. Comparison of external and percutaneous pin fixation with plate fixation for intraarticular distal radial fractures: A randomized study. Journal of Bone and Joint Surgery, American Volume 2008; 90(1): 16-22.
  • 28. Hegeman JH, Oskam J, Vierhout PA, Ten Duis HJ. External fixation for unstable intra-articular distal radial fractures in women older than 55 years: acceptable functional end results in the majority of the patients despite significant secondary displacement. Injury 2005; 36(2): 339-344.
  • 29. Zollinger PE, Kreis RW, van der Meulen HG, van der Elst M, Breederveld RS et al. No higher risk of CRPS after external fixation of distal radial fractures: subgroup analysis under randomised vitamin C prophylaxis. The Open Orthopedics Journal 2010; 4: 71-75.