Comparative study between volar locked plates versus closed reduction with percutaneous pinning in management of unstable extra-articular distal radius fractures

Background: Unstable extra articular fractures of distal radius need operative treatment, either by manipulation and closed pinning by K-wires, or by locked types of plates that give good anatomical restoration. Objective: To compare the volar locked plate versus manipulation and percutaneous pinning method of fixations for unstable extra articular fractures of distal radius. Methods: A prospective comparative study was conducted on 26 patients with mean age of 48.42 +/- 10.7 years having closed, unilateral, unstable extra articular distal radius fracture according to the one or more of the following criteria; (dorsal displacement >= 20 degrees, metaphyseal dorsal comminution, age >= 60 years, ulnar fracture, initial displacement >= 1cm, radial shortening >= 5 mm). Patients were divided in two treatment groups, thirteen were fixed with k-wires and thirteen with volar locked plate. The follow up visit was scheduled after 3 months after surgery to assess the union and functional outcomes using Modified Mayo score and Quick DASH score at 3 months postoperatively and then up to 6th months to assess clinical outcomes and complications for each case. Results: No significant difference in time of union was observed in both groups, but better functional outcome was seen in the locked plate group compared to the K-wire group. The total infection rate, was 4(30.76 %) patients for wire group and one (7.70%) patient for plate group, mal-union was seen in 4(30.70%) patients in wire group and one (7.70%) patient in the plate group, tendonitis was encountered in one (7.70%) patient in wire group and 3(23.08%) patients in the plate group. Painful hardware was noted in one (7.70%) patient in the wire group and 2(15.40%) patients in the plate group. Re-operation was required in 2(15.40%) patients in wire group and one (7.70 %) patients in the plate group. Conclusion: In distal radius extra articular unstable fracture, volar locked plate provides a superior functional outcome, less complications compared to closed percutaneous k-wires pinning.