Volar locking plating versus percutaneous Kirschner wires for distal radius fractures in an adult population: a meta-analysis.

BACKGROUND

This paper compares volar locking plates (VLPs) and percutaneous Kirschner wire (K-wire) fixation for distal radius fractures in an adult population up to and beyond 12 months. The aim of this review is to compare functional and radiological outcomes along with complication rates. A meta-analysis was performed to investigate this.

METHODS

A systematic review and meta-analysis was performed using the PRISMA guidelines. A search of major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL) was performed up to November 2017. Prospective and retrospective studies were included. Studies were assessed for quality using the Cochrane Risk of Bias tool. Meta-analysis was performed using the 'metafor' package with R.

RESULTS

A total of 14 studies (five randomized controlled trials and nine comparative studies) (n = 1535) were identified. Disabilities of the Arm, Shoulder and Hand (DASH) scores were statistically significant for VLP at all follow-up intervals up to and beyond 12 months. Wrist movements were statistically significant for VLP at 6 weeks. Grip strength was significantly different favouring VLP at 12 months and final follow-up. VLP provided better restoration of ulnar variance at 6 weeks, but overall radiological outcomes were similar. These results were not clinically significant. K-wires were associated with an 18% higher risk of complication but the reoperation rate was higher for VLP (4.6% versus 3.2%).

CONCLUSIONS

This study demonstrates similar clinical functional and radiological outcomes for VLP and K-wire fixation in the short and intermediate term. There is a higher rate of overall complication with K-wires, but the increased risk of reoperation must be considered when planning surgical fixation of these fractures.