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Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis
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 th...
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| Published in: | Clinical orthopaedics and related research 2015-09, Vol.473 (9), p.3017-3027 |
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| creator | Chaudhry, Harman Kleinlugtenbelt, Ydo V. Mundi, Raman Ristevski, Bill Goslings, J. C. Bhandari, Mohit |
| description | 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 |
| doi_str_mv | 10.1007/s11999-015-4347-1 |
| format | article |
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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 < 0.001) and 12 months (MD, 3.8; 95% CI, 1.2–6.3; p = 0.004). Neither of these differences exceeded the a priori-determined threshold for clinical importance (10 points). There was a small early advantage in flexion and supination in the volar locking plate group (3.7° [95% CI, 0.3°–7.1°; p = 0.04] and 4.1° [95% CI, 0.6°–7.6°; p = 0.02] greater, respectively) at 3 months, but not at later followups (6 or 12 months). There were no differences in radiographic outcomes (volar tilt, radial inclination, and radial height) between the two interventions. Superficial wound infection was more common in patients treated with K-wires (8.2% versus 3.2%; RR = 2.6; p = 0.001), but otherwise no difference in complication rates was found.
Conclusions
Despite the small number of studies and the limitations inherent in a meta-analysis, we found that volar locking plates show better DASH scores at 3- and 12-month followups compared with K-wires for displaced distal radius fractures in adults; however, these differences were small and unlikely to be clinically important. Further research is required to better delineate if there are specific radiographic, injury, or patient characteristics that may benefit from volar locking plates in the short term and whether there are any differences in long-term outcomes and complications.
Level of Evidence
Level I, therapeutic study.</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1007/s11999-015-4347-1</identifier><identifier>PMID: 25981715</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>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</subject><ispartof>Clinical orthopaedics and related research, 2015-09, Vol.473 (9), p.3017-3027</ispartof><rights>The Association of Bone and Joint Surgeons® 2015</rights><rights>The Association of Bone and Joint Surgeons 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-f494a503974b050acf1fb02c430f7fec689d59c1f07db79cb7ac5798d23bcaca3</citedby><cites>FETCH-LOGICAL-c503t-f494a503974b050acf1fb02c430f7fec689d59c1f07db79cb7ac5798d23bcaca3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523532/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523532/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,313,314,727,780,784,792,885,27922,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25981715$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chaudhry, Harman</creatorcontrib><creatorcontrib>Kleinlugtenbelt, Ydo V.</creatorcontrib><creatorcontrib>Mundi, Raman</creatorcontrib><creatorcontrib>Ristevski, Bill</creatorcontrib><creatorcontrib>Goslings, J. C.</creatorcontrib><creatorcontrib>Bhandari, Mohit</creatorcontrib><title>Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><addtitle>Clin Orthop Relat Res</addtitle><description>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 < 0.001) and 12 months (MD, 3.8; 95% CI, 1.2–6.3; p = 0.004). Neither of these differences exceeded the a priori-determined threshold for clinical importance (10 points). There was a small early advantage in flexion and supination in the volar locking plate group (3.7° [95% CI, 0.3°–7.1°; p = 0.04] and 4.1° [95% CI, 0.6°–7.6°; p = 0.02] greater, respectively) at 3 months, but not at later followups (6 or 12 months). There were no differences in radiographic outcomes (volar tilt, radial inclination, and radial height) between the two interventions. Superficial wound infection was more common in patients treated with K-wires (8.2% versus 3.2%; RR = 2.6; p = 0.001), but otherwise no difference in complication rates was found.
Conclusions
Despite the small number of studies and the limitations inherent in a meta-analysis, we found that volar locking plates show better DASH scores at 3- and 12-month followups compared with K-wires for displaced distal radius fractures in adults; however, these differences were small and unlikely to be clinically important. Further research is required to better delineate if there are specific radiographic, injury, or patient characteristics that may benefit from volar locking plates in the short term and whether there are any differences in long-term outcomes and complications.
Level of Evidence
Level I, therapeutic study.</description><subject>Biomechanical Phenomena</subject><subject>Bone Plates</subject><subject>Bone Wires</subject><subject>Chi-Square Distribution</subject><subject>Conservative Orthopedics</subject><subject>Equipment Design</subject><subject>Fracture Fixation, Internal - adverse effects</subject><subject>Fracture Fixation, Internal - instrumentation</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Odds Ratio</subject><subject>Orthopedics</subject><subject>Postoperative Complications - etiology</subject><subject>Radius Fractures - diagnosis</subject><subject>Radius Fractures - physiopathology</subject><subject>Radius Fractures - surgery</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Range of Motion, Articular</subject><subject>Recovery of Function</subject><subject>Risk Factors</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Survey</subject><subject>Trauma</subject><subject>Treatment Outcome</subject><subject>Wrist Injuries - diagnosis</subject><subject>Wrist Injuries - physiopathology</subject><subject>Wrist Injuries - surgery</subject><subject>Wrist Joint - physiopathology</subject><subject>Wrist Joint - surgery</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNp1kV1vFCEYhYnR2LX6A7wxJN54g-WFYRluNJt-aOMaG7_iHWEYWKmzwwqMpv9e1qlNNfEKyHneA4eD0GOgz4FSeZQBlFKEgiANbySBO2gBgrUEgLO7aEEpVUQx-HKAHuR8WY-8Eew-OmBCtSBBLJBfJYc_x8EkvI72Wxg3-GIwxWX8Ydq5FGLCJeILl-xUzOjilPEb8jOkCviqnYRczIDfmz5U5SwZW6aqvcQr_NYVQ8xohqsc8kN0z5shu0fX6yH6dHb68fg1Wb97dX68WhMrKC_EN6oxdadk01FBjfXgO8psw6mX3tllq3qhLHgq-04q20ljhVRtz3hnjTX8EL2YfXdTt3W9dWNJZtC7FLYmXelogv5bGcNXvYk_dP0XLjirBs-uDVL8Prlc9DZk64ZhDq9BUmgV53JZ0af_oJdxSjXwb4oqtuRiT8FM2RRzTs7fPAao3reo5xZ1bVHvW9RQZ57cTnEz8ae2CrAZyFUaNy7duvq_rr8AmDWpCQ</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Chaudhry, Harman</creator><creator>Kleinlugtenbelt, Ydo V.</creator><creator>Mundi, Raman</creator><creator>Ristevski, Bill</creator><creator>Goslings, J. C.</creator><creator>Bhandari, Mohit</creator><general>Springer US</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150901</creationdate><title>Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis</title><author>Chaudhry, Harman ; Kleinlugtenbelt, Ydo V. ; Mundi, Raman ; Ristevski, Bill ; Goslings, J. C. ; Bhandari, Mohit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c503t-f494a503974b050acf1fb02c430f7fec689d59c1f07db79cb7ac5798d23bcaca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Biomechanical Phenomena</topic><topic>Bone Plates</topic><topic>Bone Wires</topic><topic>Chi-Square Distribution</topic><topic>Conservative Orthopedics</topic><topic>Equipment Design</topic><topic>Fracture Fixation, Internal - adverse effects</topic><topic>Fracture Fixation, Internal - instrumentation</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Odds Ratio</topic><topic>Orthopedics</topic><topic>Postoperative Complications - etiology</topic><topic>Radius Fractures - diagnosis</topic><topic>Radius Fractures - physiopathology</topic><topic>Radius Fractures - surgery</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Range of Motion, Articular</topic><topic>Recovery of Function</topic><topic>Risk Factors</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Survey</topic><topic>Trauma</topic><topic>Treatment Outcome</topic><topic>Wrist Injuries - diagnosis</topic><topic>Wrist Injuries - physiopathology</topic><topic>Wrist Injuries - surgery</topic><topic>Wrist Joint - physiopathology</topic><topic>Wrist Joint - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chaudhry, Harman</creatorcontrib><creatorcontrib>Kleinlugtenbelt, Ydo V.</creatorcontrib><creatorcontrib>Mundi, Raman</creatorcontrib><creatorcontrib>Ristevski, Bill</creatorcontrib><creatorcontrib>Goslings, J. C.</creatorcontrib><creatorcontrib>Bhandari, Mohit</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chaudhry, Harman</au><au>Kleinlugtenbelt, Ydo V.</au><au>Mundi, Raman</au><au>Ristevski, Bill</au><au>Goslings, J. C.</au><au>Bhandari, Mohit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis</atitle><jtitle>Clinical orthopaedics and related research</jtitle><stitle>Clin Orthop Relat Res</stitle><addtitle>Clin Orthop Relat Res</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>473</volume><issue>9</issue><spage>3017</spage><epage>3027</epage><pages>3017-3027</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>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 < 0.001) and 12 months (MD, 3.8; 95% CI, 1.2–6.3; p = 0.004). Neither of these differences exceeded the a priori-determined threshold for clinical importance (10 points). There was a small early advantage in flexion and supination in the volar locking plate group (3.7° [95% CI, 0.3°–7.1°; p = 0.04] and 4.1° [95% CI, 0.6°–7.6°; p = 0.02] greater, respectively) at 3 months, but not at later followups (6 or 12 months). There were no differences in radiographic outcomes (volar tilt, radial inclination, and radial height) between the two interventions. Superficial wound infection was more common in patients treated with K-wires (8.2% versus 3.2%; RR = 2.6; p = 0.001), but otherwise no difference in complication rates was found.
Conclusions
Despite the small number of studies and the limitations inherent in a meta-analysis, we found that volar locking plates show better DASH scores at 3- and 12-month followups compared with K-wires for displaced distal radius fractures in adults; however, these differences were small and unlikely to be clinically important. Further research is required to better delineate if there are specific radiographic, injury, or patient characteristics that may benefit from volar locking plates in the short term and whether there are any differences in long-term outcomes and complications.
Level of Evidence
Level I, therapeutic study.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>25981715</pmid><doi>10.1007/s11999-015-4347-1</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical orthopaedics and related research, 2015-09, Vol.473 (9), p.3017-3027 |
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| 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 |
| title | Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis |
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