Percutaneous Pinning Versus Volar Locking Plate Fixation in the Treatment of Intra_articular Distal Radius Fracture in Adults above 18 Years of Age

Thaqaf Alauldeen Fadhil Al-bayati; Omer Ali Rafiq Barawi; Hasan Mazin Shekheel Mercalose

doi:10.56056/amj.2022.167

Authors

Thaqaf Alauldeen Fadhil Al-bayati MBCHB, KBMS (Orthopedics) trainee, Erbil Teaching Hospital
Omer Ali Rafiq Barawi MBCHB, F.I.C.M.S, M.D.O.A. the Netherlands, Prof. Orthopedic surgeon, School of Medicine/Sulaimani University
Hasan Mazin Shekheel Mercalose MBCHB, KBMS (Orthopedics) trainee, Erbil Teaching Hospital

DOI:

https://doi.org/10.56056/amj.2022.167

Keywords:

Distal radius fracture, C1 AO type, Kirschner wire, Volar locking plating

Abstract

Background and objectives: Distal radius fractures account for more than 20% of all fractures seen in the emergency department, unstable distal radial fractures can be managed by several treatment options including cast immobilization, percutaneous pinning, plate fixation, and external fixation, the aim of the study is to compare percutaneous pinning and volar locking plate in the treatment of distal radius fracture AO C1 subtype.

Methods: Thirty patients were included and divided into 2 equal groups, group 1 underwent volar locking plate fixation and group 2 underwent percutaneous k wire fixation, the functional and radiological outcomes were assessed by DASH and Stewart’s score respectively and the range of motion was measured.

Results: Plate group has significantly higher mean flexion at 3 and 12 months than those of the pin group, DASH score at 3 and 6 months was significantly higher in pin group (28.43 and 10.59 respectively) than plate group (20.47 and 16.75 respectively) but no significant difference was showed between the pin and plate groups at 12 months (14.58 vs 13.23 respectively). When the difference between preoperative and 12 months radiographs was measured ulnar variance, radial inclination, and palmar tilt were significantly higher in the plating group, however, Stewart’s score distribution between both groups showed no significant differences.

Conclusions: While there was no functional outcome difference at one year of follow-up between patients treated with either treatment modality, patients requiring faster recovery and return to function can be offered open reduction and volar locking plate fixation.

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References

Grewal R, Perey B, Wilmink M, et al. A randomized prospective study on the treatment of intra-articular distal radius fractures: Open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation. Hand Surg Am. 2005; 30(4):764-72.

Hammert WC, Kramer RC, Graham B, et al. AAOS Appropriate use criteria: Treatment of distal radius fractures. Am Acad Orthop Surg. 2013; 21(8):506-9.

Atroshi I, Brogren E, Larsson GU, et al. Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: A randomized assessor-blind clinical trial of 38 patients followed for 1 year. Acta Orthop. 2006;77(3):445-53.

Abe Y, Doi K, Kuwata N, et al. Surgical options for distal radial fractures: Indications and limitations. Arch Orthop Trauma Surg. 1998;117(4-5):188-92.

Subramanian P, Kantharuban S, Shilston S, et al. Complications of Kirschner-wire fixation in distal radius fractures. Tech Hand Up Extrem Surg. 2012;16(3):120-3.

Hull P, Baraza N, Gohil M, et al. Volar Locking Plates Versus K-wire fixation of dorsally displaced distal radius fractures-- A functional outcome study. Trauma.2011;70(6): E125-8.

McFadyen I, Field J, McCann P, et al. Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial. Injury. 2011; 42(2):162-6.

Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. Hand Surg Am. 2004;29(1):96–102.

Bentohami A, de Burlet K, de Korte N, et al. Complications following volar locking plate fixation for distal radial fractures: A systematic review. Hand Surg Eur Vol. 2014;39(7):745–54.

Andersen DJ, Blair WF, Steyers CM Jr, et al. Classification of distal radius fractures: An analysis of interobserver reliability and interobserver reproducibility. Hand Surg Am. 1996;21(4):574–82.

Canale S. Terry, Beaty James H, Azar Frederick M. Campbell's Core Orthopaedic Procedures. 12th ed. Canada, Elsevier, 2016.

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder, and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602–8.

Stewart HD, Innes AR, Burke FD. Functional cast-bracing for Colles’ fractures. A comparison between cast-bracing and conventional plaster casts. Bone Joint Surg Br. 1984;66(5): 749-53.

Yetkin H, Altay T, Ozan T, et al. Comparison of open reduction volar locking plate fixation and closed reduction percutaneous K-wire fixation in the treatment of AO type C1 distal radius fractures. Int J Clin Exp Med. 2017;10(1):1139-44

Hollevoet N, Vanhoutte T, Vanhove W, et al. Percutaneous K-wire fixation versus palmar plating with locking screws for Colles’ fractures. Acta Orthop. Belg. 2011, 77(2), 180-7.

Goehre F, Otto W, Schwan S, et al. Comparison of palmar fixed-angle plate fixation with K-wire fixation of distal radius fractures (AO A2, A3, C1) in elderly patients. Hand Surg Eur Vol. 2014;39(3):249–57.

Bahari-Kashani M, Taraz-Jamshidy MH, Rahimi H, et al. Outcomes of pin and plaster versus locking plate in distal radius intraarticular fractures. Trauma Mon. 2013;17(4):380-5.

Chaudhry H, Kleinlugtenbelt YV, Mundi R, et al. Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A meta-analysis. Clin Orthop Relat Res. 2015; 473(9): 3017-27.