Use of volar locking plate versus intramedullary nailing for fixation of distal radius fractures: a retrospective analysis of clinical and radiographic outcomes

Abstract

Background: The objective of this study was to evaluate clinical and radiographic outcomes of volar plate versus intramedullary nailing for fixation of distal radius fractures. Material/Methods: This 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. Results: Time 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). Conclusions: Both 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.