Fixation Tech
Strong evidence suggests no significant difference in radiographic or patient reported outcomes between fixation techniques for complete articular or unstable distal radius fractures, although volar locking plates lead to earlier recovery of function in the short term (3 months).
Management of Distal Radius Fractures
This guideline was produced in collaboration with ASSH Endorsed by: AAHS, ASHT

Rationale

This guideline is based upon 6 high quality studies, with 3 comparing different fixation techniques for complete intra-articular distal radius fractures (Jakubietz, Yazdanshenas, Hammer) and 3 comparing different fixation techniques for unstable distal radius fractures (Marcheix, Rozental, Goehre). Yazdanshenas compared external fixation to a “pins and plaster” technique, Jakubietz compared volar and dorsal locking plate fixation and Hammer compared volar locking plates to augmented external fixation. Early in the recovery period the 2 studies that compared volar locked plating demonstrated more rapid recovery of function but at longer term follow up, no significant differences were seen in radiographic outcomes or patient reported outcomes. Marchiex, Rozental, and Goehre each compared volar locked plating to closed reduction and percutaneous fixation and included intra- articular and extra-articular fractures. All 3 demonstrated earlier return of function for the volar locked plating group in the recovery period but the 2 studies with results at 12 months or longer, showed no difference in patient reported outcomes at final follow-up.

 

Risks and Harms of Implementation

There are no known harms associated with implementing this recommendation beyond those attributed to an open surgery and placing a volar plate (e.g. symptomatic hardware or tendon rupture).

 

Future Research

The current literature suggests that function recovers earlier in patients treated with volar locked plating than with other methods, but outcomes equalize before a year from injury.  Further randomized controlled trials should help address multiple questions including long term complication profiles (tendon ruptures, secondary surgery etc.) and the impact of the differences in cost between various treatment approaches. Further, studies that use fracture type (e.g. extraarticular, partial articular, etc.) to group patients may lead to more actionable results that can be applied to real life care.


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