Use of Volar Locking Plate Versus Intramedullary Nailing for Fixation of Distal Radius Fractures: A Retrospective Analysis of Clinical and Radiographic Outcomes.

Abstract

BackgroundThe objective of this study was to evaluate clinical and radiographic outcomes of volar plate versus intramedullary nailing for fixation of distal radius fractures.Material/MethodsThis retrospective study included 64 patients with extra-articular and simple intra-articular fractures of the distal radius who underwent intramedullary fixation using volar locking plate (n=35, mean age 47.3±16.4 years, 82.9% female) or intramedullary nailing (n=29, mean age 51.3±10.1 years, 58.6% female). Outcome measures were range of motion (ROM); visual analog scale (VAS); Disabilities of the Arm, Shoulder, and Hand (DASH) score; Gartland-Werley score; Stewart score; and radiographic findings.ResultsTime to fracture union was 5.5±1.2 and 5.2±0.6 weeks after volar plate fixation and intramedullary nailing, respectively (p>0.05). Compared to volar plate fixation, intramedullary nailing provided better restoration of volar tilt (6.9±6.3° vs. 9.4±1.6°, p=0.004) and wrist flexion (74.3±15.1° vs. 67.9±13.1°, p=0.003). However, volar plate fixation was significantly better in restoration of supination (85.0±8.3° vs. 81.9±5.1°, p=0.001) and radio-ulnar variance (0.7±0.8 mm vs. 1.1±0.9 mm, p=0.05), DASH score (9.2± 9.0 vs. 15.0 ±3.3, p=0.035), and Gartland-Werley score (1.8±0.9 vs. 4.9±5.4, p=0.004). Volar plate and intramedullary nailing groups were comparable with respect to Stewart score (1.5±0.7 and 1.6±1.3, p>0.05) and complication rates (34.3% vs. 37.9%, p>0.05).ConclusionsBoth volar plate fixation and intramedullary nail fixation provide good clinical and radiographic outcomes for primarily extra-articular or simple intra-articular distal radius fractures. As intramedullary nailing provides better restoration of volar tilt and wrist flexion, volar plate fixation provides better restoration of radio-ulnar variance and wrist supination.