The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities.

Wen-Jun Qiu,Yue-Qing Jia,Wei Xu,Xiao-Dong Zhu,Huan-Li Zhao,Xian-Zhong Tang,Feng-Fang Zhang,Shi-Cai Zhu,Gui-Bin Wang,Yi-Fan Li,Hong-Mei Liu,Yun-Han Ji

doi:10.1038/srep15318

Abstract

In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined.

Highlights

Pattern of injury to ensure successful surgical outcomes and to avoid postoperative complications
Studies were selected for incorporation into this network meta-analysis if they conformed to the following inclusion criteria: (1) study type: randomized clinical trials (RCTs); (2) interventions: bridging external fixation, non-bridging external fixation, Kirschner wire (K-wire) fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating; (3) study subjects: patients clinically or radiologically confirmed as Distal radius fracture (DRF); (4) study outcomes: incidence of carpal tunnel syndrome (CTS), chronic regional pain syndrome (CRPS) and pin-track infection (PTI) rate in DRF patients
With respect to the outcome indictors, 12 studies reported the incidence of CTS, 19 studies reported PTI rate, and 17 studies reported the incidence of CRPS

Summary

Introduction

Pattern of injury to ensure successful surgical outcomes and to avoid postoperative complications. Surgical interventions for DRFs include bridge plating, percutaneous Kirschner wire (K-wire) fixation, closed reduction and cast immobilization, fixation with volar or dorsal plates[7]. Non-bridging external fixation of DRFs is a general technique associated with lower risk of dorsal malunion, compared to bridging external fixation[10]. Compared to dorsal plating, volar plating has better soft-tissue coverage and less tendon irritation[14]. Dorsal and volar plating with conventional plates report good clinical outcomes in younger patients sustaining variety of complex fractures[15]. We use network meta-analysis to compare the risks of postoperative complications in DRF patients treated with bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating

Methods

Results

Conclusion