Published: 2017-06-23

Comparison of outcome of extra articular lower end radius fracture with percutaneous pinning and volar locking plate

Saranjeet Singh Jagdev, Rishabh Kedia, Subodh Kumar Pathak, Abhijeet Salunke


Background: As fractures of the distal radius are the most common fractures of the upper extremity with no clear guidelines for mode of intervention it was decided to compare two of the most common methods of treatment. The aim of this study was to review a group of patients sustaining extra articular lower end radius fracture treated with percutaneous wiring and volar plating and compare their functional outcome at a significant follow up time.

Methods: A prospective study was conducted at tertiary care center. A sample of 45 patients who had a displaced extra articular distal radius fracture and were subjected to treatment with either a plate (n =24) or k wiring (n =21). Outcome assessments were conducted at 6 months. Outcomes were measured on the basis of scores on the DASH questionnaire, wrist range of motion, and radiographic parameters.

Results: Patients in the plate group had significantly better DASH scores (p=0.0431) and range of motion at six months compared with patients in the k wiring group. Collapse in radial length was observed in 2 patients with percutaneous wiring which led to suboptimal range of motion and increased DASH scores. Significance arc of motion at 6months in dorsiflexion and palmar flexion were p=0.0038 and when compared with opposite limb were significant in all three planes p=0.0217, p=0.0126 and p=0.0029.

Conclusions: Based on our observation we found that treatment of dorsally displaced, unstable extra articular radius fractures across all age groups, volar-locked plates achieve a superior radiological and functional outcome with minimal complications.


Distal radius fractures, Extra articular, Locking plates, DASH score, K wire

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Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the U.S. 11 Medicare population. J Clin Epidemiol. 1999;52:243-9.

Knirk JL, Jupiter JB. Intra articular fractures of the distal end of radius in young adults. J Bone Joint Surg Arm. 1986;68:647-59.

Jupiter JB, Ring D, Weitzel PP. Surgical treatment of re displacedof the distal radius in patients older than 60 years. J Hand Surg Am. 2002;27:714-23.

Dóczi J, Renner A. Epidemiology of distal radius fractures in Budapest. A retrospective study of 2,241 cases in 1989. Acta Orthop Scand. 1994;65:432-3.

Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand. 1985;56:391-3.

Mallmin H, Ljunghall S. Incidence of Colles′ fracture in Uppsala. A prospective study of a quarter-million population. Acta Orthop Scand. 1992;63:213-5.

Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring D. Distal radius work group: The treatment of distal radius fractures. J Am Acad Orthop Surg. 2010;18:180-9.

Handoll HH, Huntley JS, Madhok R. External fixation versus conservative management for distal radius fractures in adults. Cochrane Database Syst Rev. 2007;18(3):CD006194.

Mah ET, Atkinson RN. Percutaneous Kirschner wire stabilisation following closed reduction of colles fracture. J Hand Surg Br. 1992;17:55-62.

Willis AA, Kutsumi K, Zobitz ME, Cooney WP, 3rd. Internal fixation of dorsally displaced fracturesof the distal radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am. 2006;88:2411-7.

Knox J, Ambrose H, McCallister W, Trumble T. Percutaneous Pins Versus Volar Plates for Unstable Distal Radius Fractures: A Biomechanic Study Using a Cadaver. J Hand Surg Am. 2007;32(6):813-7.

Downing ND, Karantana A. A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br. 2008;90:1271-5.

Kiliç A, Kabukçuoglu Y, Ozkaya U, Gül M, Sökücü S, Ozdogan U. Volar locking plate fixation of unstable distal radius fractures. Acta Orthop Traumatol Turc. 2009;43:303-8.

Othman AY. Fixation of dorsally displaced distal radius fractures with volar plate. J Trauma. 2009;66:1416-20.

Khan SM, Saxena NK, Singhania SK, Gudhe M, Nikose S, Arora M, et al. Volar plating in distal end radius fractures and its clinical and radiological outcome as compared to other methods of treatment. J Orthop Allied Sci. 2016;4:40-4.

McFadyen I, Field J, McCann P, Ward J, Nicol S, Curwen C. Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial. Injury. 2011;42:162-6.

Oshige T, Sakai A, Zenke Y, Moritani S, Nakamura T. A comparative study of clinical and radiological outcomes of dorsally angulated, unstable distal radius fractures in elderly patients: intrafocal pinning versus volar locking plating. J Hand Surg Am. 2007;32:1385.

Voigt C, Lill H. What advantages does volar plate fixation have over K-wire fixation for distal radius extension fractures in the elderly? Unfallchirurg. 2006;109(10):845-6,848-54.

Rozenthal TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006;31:359-65.

Karantana A. Fractures of the distal radius:does operative treatment with a volar locking plateimprove outcome?: a randomised controlled trial. PhD thesis, University of Nottingham, 2014.