A Comparison Between Volar Locking Plates and Percutaneous Pinning in the Treatment of Distal Radius Fractures: A Systematic Review

IF 2.1 2区 医学 Q2 ORTHOPEDICS Journal of Hand Surgery-American Volume Pub Date : 2025-03-01 DOI:10.1016/j.jhsa.2024.08.016
Nikhil Gopal MBBS , Abhijith Anil MBBS, MS , Meera Gopal MBBS , Anil K. Bhat MBBS, MS
{"title":"A Comparison Between Volar Locking Plates and Percutaneous Pinning in the Treatment of Distal Radius Fractures: A Systematic Review","authors":"Nikhil Gopal MBBS ,&nbsp;Abhijith Anil MBBS, MS ,&nbsp;Meera Gopal MBBS ,&nbsp;Anil K. Bhat MBBS, MS","doi":"10.1016/j.jhsa.2024.08.016","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Percutaneous fixation with Kirschner wires and open reduction and internal fixation with volar locking plates are the most common surgical techniques for managing distal radius fractures (DRFs). As the superiority of either technique is yet to be established, we aimed to conduct an updated systematic review to compare these techniques for the optimal management of unstable DRFs.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive literature search to identify studies comparing fixation outcomes for DRFs between groups treated with Kirschner wires and those treated with volar locking plates. Only randomized controlled trials (RCTs) were included. The revised Cochrane risk-of-bias tool was used to assess the methodological quality of RCTs. Meta-analyses were performed only on outcome measures that were reported at the same time points using the same metrics across three or more RCTs. Evaluated outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, wrist range of motion, and radiological outcomes. We also assessed the Patient-Rated Wrist Evaluation (PRWE) score and incidence of complications.</div></div><div><h3>Results</h3><div>Fourteen RCTs with 2,226 patients were included in the meta-analysis. DASH scores were significantly lower in the plating group at all time points. PRWE outcomes favored the plating group at follow-ups greater than 1 year. There were no significant differences in radiological outcomes or incidence of complications between the two groups.</div></div><div><h3>Conclusions</h3><div>Although the plating group provided marginally better functional outcomes at 1 year after surgery, the K-wire group remained a viable alternative. The reported differences should be interpreted cautiously because of the inherent variability of the included RCTs. High-quality RCTs with strict inclusion criteria and standard postoperative protocols are essential to generalize our results across all age groups and fracture types to overcome our study’s limitations.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapy/Prevention, Etiology/Harm II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 265-273"},"PeriodicalIF":2.1000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery-American Volume","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0363502324004088","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose

Percutaneous fixation with Kirschner wires and open reduction and internal fixation with volar locking plates are the most common surgical techniques for managing distal radius fractures (DRFs). As the superiority of either technique is yet to be established, we aimed to conduct an updated systematic review to compare these techniques for the optimal management of unstable DRFs.

Methods

We conducted a comprehensive literature search to identify studies comparing fixation outcomes for DRFs between groups treated with Kirschner wires and those treated with volar locking plates. Only randomized controlled trials (RCTs) were included. The revised Cochrane risk-of-bias tool was used to assess the methodological quality of RCTs. Meta-analyses were performed only on outcome measures that were reported at the same time points using the same metrics across three or more RCTs. Evaluated outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, wrist range of motion, and radiological outcomes. We also assessed the Patient-Rated Wrist Evaluation (PRWE) score and incidence of complications.

Results

Fourteen RCTs with 2,226 patients were included in the meta-analysis. DASH scores were significantly lower in the plating group at all time points. PRWE outcomes favored the plating group at follow-ups greater than 1 year. There were no significant differences in radiological outcomes or incidence of complications between the two groups.

Conclusions

Although the plating group provided marginally better functional outcomes at 1 year after surgery, the K-wire group remained a viable alternative. The reported differences should be interpreted cautiously because of the inherent variability of the included RCTs. High-quality RCTs with strict inclusion criteria and standard postoperative protocols are essential to generalize our results across all age groups and fracture types to overcome our study’s limitations.

Type of study/level of evidence

Therapy/Prevention, Etiology/Harm II.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
在治疗桡骨远端骨折时,比较沃尔锁定钢板和经皮穿刺钉:系统回顾
目的:使用 Kirschner 钢丝进行经皮固定和使用外侧锁定钢板进行切开复位内固定是治疗桡骨远端骨折(DRF)最常用的手术技术。由于这两种技术的优越性尚未确定,我们旨在开展一项最新的系统性综述,对这两种技术进行比较,以优化不稳定桡骨远端骨折的治疗:我们进行了全面的文献检索,以确定对使用 Kirschner 钢丝治疗和使用外侧锁定钢板治疗的 DRFs 固定效果进行比较的研究。仅纳入了随机对照试验(RCT)。修订后的 Cochrane 偏倚风险工具用于评估 RCT 的方法学质量。仅对三项或三项以上随机对照试验在相同时间点使用相同指标报告的结果指标进行了 Meta 分析。评估的结果包括手臂、肩部和手部残疾(DASH)评分、握力、腕部活动范围和放射学结果。我们还评估了患者评定的腕部评估(PRWE)评分和并发症的发生率:荟萃分析共纳入了 14 项研究,2226 名患者。在所有时间点上,钢板组的 DASH 评分都明显较低。在随访一年以上时,PRWE结果更倾向于固定组。两组在放射学结果或并发症发生率方面无明显差异:结论:尽管在术后1年,钢板组的功能结果略好于K线组,但K线组仍然是一个可行的替代方案。由于所纳入的研究性临床试验存在固有的差异性,因此应谨慎解释所报告的差异。要在所有年龄组和骨折类型中推广我们的结果,就必须进行具有严格纳入标准和标准术后方案的高质量研究,以克服我们研究的局限性:治疗/预防,病因/危害 II.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
3.20
自引率
10.50%
发文量
402
审稿时长
12 weeks
期刊介绍: The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.
期刊最新文献
The Rate of Major Complications Following Distal Radial Fractures Treated With One Specific Volar Locking Plate: A Retrospective Study of 1,597 Consecutive Cases in 1,564 Patients. Development of an Amyloidosis Risk Score for Positive Tenosynovial Biopsy at Carpal Tunnel Release. Prophylactic Antibiotics for Uncomplicated Upper-Extremity Lacerations: A Retrospective Cohort Study of Private Insurance Claims. The Effect of Epitendinous-First Repair of Flexor Digitorum Profundus in Zone II on Gapping and Load-To-Failure in a Cadaveric Simulated Active Motion Model. Three-Dimensional In Vivo Kinematic Analysis of Kienböck Disease Treated with Arthroscopic Lunate Excision.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1