Volar locking plate versus percutaneous fixation for the treatment of distal radial fractures: a meta-analysis of randomized controlled trials

Background: Although operative fixation with a volar locking plate is becoming increasingly popular for treatment of distal radius fractures, it is not clear whether it is superior to other conventional treatment methods such as percutaneous fixation with Kirschner wires. The present meta-analysis compared the effects of internal fixation with volar locking plates and percutaneous fixation for the treatment of distal radius fractures. Methods: A literature search was performed without language restrictions and all randomized controlled studies comparing the effects of volar locking plates and percutaneous fixation for the treatment of distal radial fractures were included. Data of function scores, range of motion, grip strength, radiographic results, and complications were pooled and analyzed with a standard meta-analytical method. Results: Seven studies in seven publications were included. Pooled data indicated that there were no significant differences in Patient-Related Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores between the two treatment methods postoperatively. Fixation with volar locking plates took significantly longer than percutaneous fixation. There was a significant difference in supination and grip strength favoring volar locking plate fixation at 3 and 6 months but not at >= 12 months, postoperatively. The final complication rates were similar in the two treatment groups. Conclusion: In the management of distal radius fractures, volar locking plate and percutaneous fixation yielded similar outcomes, while the former had the advantage of supination and grip strength in the early stage postoperatively. Percutaneous fixation was quicker to perform than volar locking plate fixation.