Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis.

Abstract

This study aims to compare the outcomes of intramedullary nail (IMN) and volar locking plate (VLP) fixation for treatment of extra-articular or simple intra-articular distal radius fractures. PubMed, Embase, Medline and Cochrane Collaboration Central databases were searched for studies that compared the results of IMN and VLP fixation for the treatment of distal radius fractures up to March 2016. Stata 11.0 was used to perform the meta-analysis. Six randomized controlled trials (RCT) and two retrospective studies were included in this review, including 463 patients. No significant differences were found between two treatment methods in terms of any functional score, radiographic parameters and motion range in the late post-operative period (6, 12 and 24months). However, IMN did better than VLP at the post-operative sixweeks and threemonths, no matter which functional scoring system was used. The incidence of carpal tunnel syndrome (CTS) was 8.7% in the VLP group, significantly higher than that (0.8%) in the IMN group (OR, 0.183; 95%CI, 0.045-0.74). But for other complications, such as infection (OR, 0.449; 95%CI, 0.095-2.114), tendious damage (OR, 0.931; 95%CI, 0.238-3.648), tenosynovitis (OR, 0.806; 95%CI, 0.209-3.108), algodystrophy (pain) (OR, 0.795; 95%CI, 0.291-2.173) and radial nerve paraesthesia (OR, 1.8143; 95%CI, 0.834-3.942), no significant differences were found (P > 0.05). Compared to VLP, IMN could provide better early postoperative functional outcomes and reduce the incidence of carpal tunnel syndrome, which could be of particular help in restoring confidence for workers with specialized manual skills to return to their prior jobs. Additionally, the conclusion should be cautiously treated, because it was reached in the context of limited amount of studies and relatively small sample size. Therefore, future studies with good design and large samples are required to verify this conclusion.