Comparison of Surgical Technique Modification
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1
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Häberle et al.3131 Häberle S, Sandmann GH, Deiler S, et al. Pronator quadratus repair after volar plating of distal radius fractures or not? Results of a prospective randomized trial. Eur J Med Res 2015;20:93 (2015) |
An improved pronation strength after PQ repair in the early rehabilitation period could not be confirmed. However, the PQ repair might reduce pain in the early postoperative period. |
PQ repair: 3.5 (0–55); no repair: 5 (0–23); data expressed as median (range) |
NA |
NA |
NA |
Pain level between 0 and 2– PQ repair: 91%; no repair: 93% |
NA |
2
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Hohendorff et al.3232 Hohendorff B, Knappwerth C, Franke J, Müller LP, Ries C. Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial. Arch Orthop Trauma Surg 2018;138(10): 1479-1485 (2018) |
PQ repair with insertion of a part of the BR muscle is a reliable technique to cover a VLP by slight distal transposition. |
VLP + PQ repair: 9(11); VLP: 2(3) |
NA |
NA |
NA |
VLP + PQ repair: 9(1); VLP: 9(1) |
None |
3
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Sonntag et al.3333 Sonntag J, Woythal L, Rasmussen P, et al. No effect on functional outcome after repair of pronator quadratus in volar plating of distal radial fractures: a randomized clinical trial. Bone Joint J 2019;101-B(12):1498-1505 (2019) |
PQ repair made no difference to the clinical outcome, 12 months after DRF treat by VLP. |
PQ repair: 15 (95%CI: 9.56–20.77); no repair: 13 (95%CI: 7.03–18.56) |
PQ repair: 18.38 (95%CI: 10.34–26.41); no repair: 12.90 (95%CI 7.55–18.25) |
NA |
NA |
NA |
NA |
4
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Ma et al.2929 Ma T, Zheng X, He XB, Guo KJ. The role of brachioradialis release during AO type C distal radius fracture fixation. Orthop Traumatol Surg Res 2017;103(07):1099-1103 (2017) |
Release of the BR for type-C DRFs facilitated the surgical 3 procedure and did not adversely affect elbow and wrist function. |
BR release: 8.8 (12.3); no BR release: 7.4 (10.6) |
NA |
NA |
NA |
BR release: 0.5 (0.7); no BR release: 0.5 (0.8) |
BR release: 16.2%; no BR release: 8.1% (p= 0.708) |
5
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Zhang et al.2222 Zhang X, Huang X, Shao X, Zhu H, Sun J, Wang X. A comparison of minimally invasive approach vs conventional approach for volar plating of distal radial fractures. Acta Orthop Traumatol Turc 2017;51(02):110-117 (2017) |
Minimally-invasive VLP for DRFs is a safe and reliable technique, resulting in better pronation, function, and appearance. |
Minimally-invasive: 3.6 ± 3.71; VLP: 3.9 ± 3.66 (DASH of A3 patients) |
NA |
NA |
NA |
Minimally-invasive: 3.5 ± 3.2; VLP: 7.47 ± 6.61 (scar pain) |
NA |
Comparison of Operative Procedures
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1
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Mellstrand Navarro et al.2727 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. J Orthop Trauma 2016;30(04):217-224 (2016) |
VLP and EF with optional addition of K-wires are two equally suitable treatment options for dorsally-displaced DRFs after low-energy trauma in a population aged 50–74 years. |
VLP: 11 (0–77); EF: 13 (0–62) |
VLP: 13 (0–80); EF: 14 (0–69) |
VLP: 0.85 (0–1); EF: 0.89 (0.62–1) |
NA |
NA |
EF: reoperation (n= 3), carpal tunnel release (n= 2); VLP: reoperation (n= 2), carpal tunnel release (n= 1); plate removal within 1 year (n= 7); rupture extensor pollicis longus tendon (n= 1) |
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Saving et al.2828 Saving J, Enocson A, Ponzer S, Mellstrand Navarro C. External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures-A 3-Year Follow-Up of a Randomized Controlled Study. J Hand Surg Am 2019;44(01):18-26 (2019) |
Three years after surgery for unstable dorsally-displaced DRFs, the clinical and radiological results for VLP and EF were comparable. |
EF: 7.0 (9.9); VLP: 5.4 (7.1) |
EF: 6.6 (12.0); VLP: 6.1 (9.2) |
EF: 6.6 (12.0); VLP: 6.1 (9.2) |
NA |
NA |
Reoperation rate: 21% (13 of 62) in the VLP group, and 14% (8 of 56) in the EF group; OA rate: 42% (25 of 59) in the VLP group and 28% (15 of 53) in the EF group. |
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Hammer et al.2626 Hammer OL, Clementsen S, Hast J, Šaltytė Benth J, Madsen JE, Randsborg PH. Volar Locking Plates Versus Augmented External Fixation of Intra-Articular Distal Radial Fractures: Functional Results from a Randomized Controlled Trial. J Bone Joint Surg Am 2019;101(04):311-321 (2019) |
VLP fixation resulted in faster recovery of function compared with EF, but no functional advantage was demonstrated at two years. |
VLP: 7.6 (12.9); EF: 8.1 (14.0) |
NA |
NA |
NA |
VLP: 0.4 (1.0); EF: 0.4 (1.1) |
VLP: 44%; EF: 55% |
4
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Chung et al.2525 Chung KC, Kim HM, Malay S, Shauver MJWrist and Radius Injury Surgical Trial Group. The Wrist and Radius Injury Surgical Trial: 12-Month Outcomes from a Multicenter International Randomized Clinical Trial. Plast Reconstr Surg 2020;145(06): 1054e-1066e (2020) |
Recovery was fastest for internal fixation and slowest for EF according to most measures, but after 12 months there were no meaningful differences in outcomes. |
NA |
NA |
NA |
EF: 46 (43–49); K-wire: 48 (44–51); VLP: 46 (43–49) |
NA |
Malunion– EF: 16%; VLP 6%. VLP: wound infection (n= 1); hardware removal (n= 3) |
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Lee et a.3434 Lee SK, Kim KJ, Cha YH, Choy WS. Conservative Treatment Is Sufficient for Acute Distal Radioulnar Joint Instability With Distal Radius Fracture. Ann Plast Surg 2016;77(03):297-304 (2016) |
Conservative treatment (supination sugar-tong splinting) and surgical treatments provided similar long-term outcomes for acute DRUJ instability with DRF. |
In the group without fracture of the ulnar styloid process: VLP + splint: 14 ± 10; VLP + DRUJ transfixation (K-wire): 16 ± 12; VLP + TFCC repair: 13 ± 11 |
NA |
NA |
NA |
NA |
VLP + splint: mild instability and pain (1 patient) |
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Athar et al.3535 Athar SM, Ashwood N, Aerealis G, Bain GI. Is external fixation a better way than plaster to supplement K-wires in non-comminuted distal radius fractures? Postgrad Med J 2018;94(1107):20-24 (2018) |
In the supplementation of K-wire stabilization of a non-comminuted DRF, application of an external fixator for four weeks was associated with lower pain, higher satisfaction, and greater range of supination when compared with the for-week application of a PC. |
NA |
NA |
NA |
NA |
Mean VAS – K-wire + EF: 14.9; K-wire + PC: 28.1 |
NA |
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Costa et al.2424 Costa ML, Achten J, Rangan A, Lamb SE, Parsons NR. Percutaneous fixation with Kirschner wires versus volar locking-plate fixation in adults with dorsally displaced fracture of distal radius: fiveyear follow-up of a randomized controlled trial. Bone Joint J 2019; 101-B(08):978-983 (2019) |
This follow-up study continues to show no evidence of a difference in wrist pain, wrist function, or quality of life for patients treated with wires versus locking plates in the five years following a dorsally-displaced DRF. |
K-Wire: 4.9 (11.9); VLP: 4.9 (11.3) |
K-Wire: 2.3 (7.4); VLP: 2.9 (9.5) |
NA |
K-Wire: 0.93 (0.16); VLP: 0.93 (0.17) |
NA |
K-Wire: restricted wrist movement (n= 1); VLP: late tendon rupture (n= 1), retained suture removal (n= 1) |
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Gradl et al.3636 Gradl G, Falk S, Mittlmeier T, Wendt M, Mielsch N, Gradl G. Fixation of intra-articular fractures of the distal radius using intramedullary nailing: a randomized trial versus palmar locking plates. Injury 2016;47(Suppl 7):S25-S30 (2016) |
IM nail fixation is a reasonable alternative to VLP fixation for the treatment of intra-articular DRFs, and both techniques can yield reliably good results. |
NA |
NA |
NA |
NA |
VLP: 0.00 ± 0.00; IM nail: 0.91 ± 2.21 |
VLP: carpal tunnel release (n= 1), implant removal (n= 1); IM nail: paresthesia of the superficial radial nerve (n= 1), implant removal (n= 1) |
Comparison of Different Plates
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Tanaka et al.3030 Tanaka H, Hatta T, Sasajima K, Itoi E, Aizawa T. Comparative study of treatment for distal radius fractures with two different palmar locking plates. J Hand Surg Eur Vol 2016;41(05):536-542 (2016) |
Internal fixation using palmar locking plates with different placements in relationship to the watershed line provide similar and satisfactory outcomes six months after surgery. However, locking plates placed distal to the watershed line may delay recovery of the wrist ROM. |
Distal to watershed line: 14.9 (12.1); proximal to watershed line: 12.8 (9.2) |
NA |
NA |
NA |
NA |
Distal to watershed line: extensor tendon rupture (n= 1), CRPS (n= 1); proximal to watershed line: CRPS (n= 1) |
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Perugia et al.3737 Perugia D, Guzzini M, Mazza D, Iorio C, Civitenga C, Ferretti A. Comparison between Carbon-Peek volar locking plates and titanium volar locking plates in the treatment of distal radius fractures. Injury 2017;48(Suppl 3):S24-S29 (2017) |
Carbon PEEK VLPs seem to be analogue to titanium VLPs in terms of radiographic parameters and functional outcome. |
Carbon PEEK 15.3 (2.5–5.89); titanium: 12.2 (10.6–54.8) |
NA |
NA |
NA |
Carbon PEEK: 3.6; titanium: 2.9 |
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Landgren et al.3838 Landgren M, Abramo A, Geijer M, Kopylov P, Tägil M. Fragment-Specific Fixation Versus Volar Locking Plates in Primarily Nonreducible or Secondarily Redisplaced Distal Radius Fractures: A Randomized Controlled Study. J Hand Surg Am 2017;42(03): 156-165.e1 (2017) |
In the treatment of primarily non-reducible or secondarily-redisplaced DRFs, VLPs and fragment-specific fixation both achieve good and similar patient-reported outcomes, although more complications were recorded in the fragment- specific group. |
VLP: 12 ± 16; fragment-specific fixation: 9 ± 9 |
NA |
NA |
NA |
VLP: 1.4 ± 2.1; fragment-specific fixation: 1.4 ± 1.8 |
VLP (n= 5); fragment-specific fixation (n= 13) (p< 0.05) |
Comparison of Postoperative Immobilization Period
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1
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Watson et al.2323 Watson N, Haines T, Tran P, Keating JL. A Comparison of the Effect of One, Three, or Six Weeks of Immobilization on Function and Pain After Open Reduction and Internal Fixation of Distal Radial Fractures in Adults: A Randomized Controlled Trial. J Bone Joint Surg Am 2018;100(13):1118-1125 (2018) |
Immobilization periods of 1 and 3 weeks produced superior short-term outcomes compared with those after 6 weeks of immobilization. These differences were not evident at 3 and 6 months following surgery, with the immobilization period having no significant effect on long-term function, ROM, or pain. There were no significant differences in adverse events associated with shorter immobilization periods. |
Immobilization for: 1 week: 12.9 (19.6); 3 weeks: 10.4 (14.7); 6 weeks: 14.4 (17.7) |
Immobilization for: 1 week: 18.2 (23.8); 3 weeks: 13.5 (14.8); 6 weeks: 21.6 (20.6) |
NA |
NA |
Immobilization for: 1 week: 11.4 (18.3); 3 weeks: 4.9 (9.7); 6 weeks: 12.2 (17.5) |
Postoperative adverse events: 1 week: 15% (n= 6); 3 weeks: 3% (n= 1); 6 weeks: 13% (n= 5) |
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Andrade-Silva et al.3939 Andrade-Silva FB, Rocha JP, Carvalho A, Kojima KE, Silva JS. Influence of postoperative immobilization on pain control of patients with distal radius fracture treated with volar locked plating: A prospective, randomized clinical trial. Injury 2019;50 (02):386-391 (2019) |
There was a trend toward a greater use of tramadol in patients who did not use immobilization and started early wrist mobilization after VLP for DRF, compared with patients who were immobilized for two weeks. The functional results and complication rates were not influenced by the use of immobilization. |
No splint: 10.4 (11.8); splint: 14.5 (20.5) |
NA |
NA |
NA |
No splint: 1.1 (1.4); splint: 1.7 (2.9) |
No splint: 1 patient with loss of fracture reduction at 6 weeks, who underwent reoperation |
3D Preoperative Planning
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Yoshii et al.1212 Yoshii Y, Totoki Y, Tung WL, Akita K, Ishii T. A Comparison of Radiographic Outcomes between 3D Preoperative Planning and Conventional Planning in the Osteosynthesis of Distal Radius Fractures. J Hand Surg Asian Pac Vol 2019;24(03): 303-310 (2019) |
3D preoperative planning offers better reduction accuracy and reduces correction loss in the osteosynthesis of DRFs. |
NA |
NA |
NA |
NA |
NA |
Loss of corrections: - difference in volar tilts = 2.53 ± 1.78 degrees (3D plan) and 4.00 ± 3.10 degrees (control) (p= 0.03); - radial inclination difference = 2.00 ± 1.58 degrees (3D plan) and 3.40 ± 3.00 degrees (control) (p= 0.03) |
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Kong et al.1111 Kong L, Yang G, Yu J, et al. Surgical treatment of intraarticular distal radius fractures with the assistance of three-dimensional printing technique. Medicine (Baltimore) 2020;99(08):e19259 (2020) |
With the assistance of the 3D printing technique, the operative time, the amount of intraoperative bleeding, and rounds of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with VLP and K-wire fixation. |
VLP + 3D model: 68.0 ± 9.6; VLP: 71.5 ± 10 |
NA |
NA |
NA |
VLP + 3D model: 3.7 ± 1.3; VLP: 14.2 ± 1.4 |
VLP + 3D model: loss of reduction (n= 1); VLP: loss of reduction (n= 1), superficial wound infection (n= 1) |