Comparison of volar locking plate and external fixation with K wire augmentation in unstable distal radius fractures

Distal radius fractures are one of the most common injuries and this incidence is likely to increase as the aging population increases. The type of operation and implant is a matter of discussion and randomized trials and meta analyses have failed to recommend the preferred implant. Internal fixation with volar locking plate and external fixation with supplementation with K wire have been successfully employed in these fractures. Forty eight patients unstable distal radius fractures treated from 2008 to 2014 with either a volar locking plate or an external fixation with K wire supplementation were analyzed. Radiographic measurements like dorsal angle in degrees, radial inclination in degrees, ulnar variance in millimeters and radial length in millimeters were taken. Functional evaluation was assessed with the clinical rating as devised by Cooney (modified from Green and O’Brien). These patients were treated with volar locking plate (n26) and external fixation with K wire (n-22). Patients were treated with a three or four holes 3.5mm volar locking plate and wrist spanning external fixator with two K wire supplementation. Sixteen A3, fourteen C1, eleven C2, and seven C3 fractures were treated. By six weeks, the mean functional outcome score in the volar plate group was significantly better than that in the external fixation group (p =0.037). At three months, the mean score in the volar plate group was significantly better than that in the external fixation group (p = 0.028). However, by six months, the score in the volar plate group was not significantly different from that in the external fixation group (p = 0.26). At one year, the mean score in the volar plate was not significantly different from the mean score in the external fixation group (p = 0.056). At one year, the degree of radial inclination and the radial length in the patients with a volar locking plate were significantly greater than those in both the patients treated with external fixation (p = 0.007 and p = 0.002, respectively). Although volar locking plate has certain advantages over the external fixation in the earlier post operative period, this decreases as time passes. Both fixation techniques seem to apply sufficient stabilization to restore and retain anatomy after fracture of distal part of the radius and should be individually chosen accordingly.