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.
- Rozental, T. D., Blazar, P. E., Franko, O. I., Chacko, A. T., Earp, B. E., Day, C. S. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. Journal of Bone & Joint Surgery - American Volume 2009; 8: 1837-46
- Goehre, F., Otto, W., Schwan, S., Mendel, T., Vergroesen, P. P., Lindemann-Sperfeld, L. Comparison of palmar fixed-angle plate fixation with K-wire fixation of distal radius fractures (AO A2, A3, C1) in elderly patients. Journal of Hand Surgery: European Volume 2014; 3: 249-57
- Yazdanshenas, Hamed, Washington, Eleby Rudolph, 3rd, Madadi, Firoozeh, Madadi, Firooz, Shamie, Arya Nick, Hornicek, Francis John, Azari, Kodi Introducing and Prospective Efficacy Comparison of an Innovative and Affordable Technique for the Treatment of Distal Radius Fractures. Journal of Orthopaedics 2019; 6: 596-602
- Jakubietz, M. G., Gruenert, J. G., Jakubietz, R. G. Palmar and dorsal fixed-angle plates in AO C-type fractures of the distal radius: is there an advantage of palmar plates in the long term?. Journal of Orthopaedic Surgery 2012; 1: 8
- Marcheix, P. S., Dotzis, A., Benko, P. E., Siegler, J., Arnaud, J. P., Charissoux, J. L. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. Journal of Hand Surgery: European Volume 2010; 8: 646-51
- Hammer, O. L., Clementsen, S., Hast, J., Saltyte Benth, J., Madsen, J. E., Randsborg, P. H. Volar Locking Plates Versus Augmented External Fixation of Intra-Articular Distal Radial Fractures: Functional Results from a Randomized Controlled Trial. Journal of Bone & Joint Surgery - American Volume 2019; 4: 311-321