SURGICAL OUTCOMES OF VOLAR LOCKING PLATE VERSUS K-WIRES FIXATION FOR DISTAL RADIUS FRACTURES

Abstract

Background and Objective: The most common hand fractures among adult population are distal radius fractures and optimal management of these fractures remains controversial. Several surgical strategies are available to treat these fractures. Two most commonly used procedures volar locking plates and percutaneous K-wire fixation are used to treat distal radius fractures.The objective of this study was to compare outcome in distal radius fractures in volar locking plate and in K-wire fixation and in terms of functional and clinical outcome. Methods: We conducted a randomized control trial at department of orthopedic surgery, Services Institute of Medical Sciences Lahore. After approval from the Ethical Review Board, a total number of 80 patients with distal radius fractures fulfilling the inclusion criteria were included. In Group A, distal radius fractures were fixed with volar locking plate and in Group B, K-wires were used to fix the distal radius fractures. Patients with polytrauma, head injury and spine injury were excluded from the study. Follow up was done at 2, 4, 6 weeks, 3 months and final at 6 months. Functional and clinical outcomes were measured with DASH Score and PREW Score at 3 months and 6 months. Results:- Age range was 18-80 years, mean age was 61.3 + 14.5 years. Mechanism of injury was fall on outstretched hands in 45 (56.2%) patients, fall from height in 20 (25.0%) patients, motorbike accidents in 7 (8.8%) patients, injury after fight in 4 (5.0%) patients and 4 (5.0%) patients were having machine injury. No difference in radiological outcomes was recorded in the final follow up. There was no difference in volar tilt loss. It was 0.5o in plate group and 0.7o in K-wires group (p = 0.92). Radial length loss was 1mm in Group A and 1.2mm in Group B (p = 0.55). The loss of angle of radial inclination was 1.2o in Group A and 1.5o in Group B (p = 0.35) at the final follow up. There were 04 cases of superficial infection in Group B (10%) versus 01 in Group A (2.5%, p = 0.001). Conclusion:- Our study shows that no mode of treatment in distal radius fractures is superior to other. The results of volar locking plate as compared to K-wire fixation were slightly better in the initial period but on long term bases both of these techniques have excellent and comparable results. DASH Score and PREW Score were almost equal in both of these techniques. The functional outcomes were almost equal in both of these techniques The complication rate although slightly more in K-wires group but it was insignificant from functional point of view.