Functional outcome of distal radius fractures, an implant based approach - Narrative review

Abstract

ObjectivesTo review the literature regarding the outcomes of the comparison of the surgical options for fixing the distal radius. To briefly document how surgical costs, operating times and complication rates may impact on the implant choice. The limitations of the literature when comparing the effectiveness of the different implants are also discussed. BackgroundThe literature on the surgical management of distal radial fractures commonly have heterogeneity in the fracture patterns and patient characteristics. Biases also occur in relation to the implants utilized, surgical training and location of the treatment facility. This article attempts to assist in the interpretation of the literature and ultimately in the decision making process of which implant to treat a specific distal radial fracture. Materials and methodsA narrative review was conducted utilising numerous research portals namely PubMed. Search terms included distal radius fractures, surgical management, plating, external fixation, surgical outcomes. ResultsCurrent level one data continues to demonstrate superior results of locked volar plating within the first six weeks compared to other implants when analysing grip strength, range of motion, and patient reported outcomes. Other implants are, however, associated with lower costs and shorter surgical times. No implant consistently demonstrated lower complication rates. ConclusionThe quicker return to function in patients treated with volar locked plating is particularly important in physiologically young patients desirous of an accelerated rehabilitation programme. Cost and surgical times are noteworthy considerations. Interpretation of comparative literature remains challenging due to diversity in patient factors and injury patterns, amongst other limitations.