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

• Published in: Clinical orthopaedics and related research 2015-09, Vol.473 (9), p.3017-3027
• Main Authors: Chaudhry, Harman, Kleinlugtenbelt, Ydo V., Mundi, Raman, Ristevski, Bill, Goslings, J. C., Bhandari, Mohit
• Format: Article
• Language: English
• Subjects: Biomechanical Phenomena; Bone Plates; Bone Wires; Chi-Square Distribution; Conservative Orthopedics; Equipment Design; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Medicine; Medicine & Public Health; Odds Ratio; Orthopedics; Postoperative Complications - etiology; Radius Fractures - diagnosis; Radius Fractures - physiopathology; Radius Fractures - surgery; Randomized Controlled Trials as Topic; Range of Motion, Articular; Recovery of Function; Risk Factors; Sports Medicine; Surgery; Surgical Orthopedics; Survey; Trauma; Treatment Outcome; Wrist Injuries - diagnosis; Wrist Injuries - physiopathology; Wrist Injuries - surgery; Wrist Joint - physiopathology; Wrist Joint - surgery
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-015-4347-1

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