An external fixator being used in the treatment of a fractured radius.
Courtesy of Dekkanar: External fixator. http://en.wikipedia.org/wiki/File:External_Fixator.JPG#file. Accessed Oct. 20, 2009

AAOS Now

Published 11/1/2009
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Peter Pollack

The less painful option: Volar plating for distal radius fractures

Volar plate fixation is associated with less ulnar-sided wrist pain and shortening than external fixation

Patients with highly comminuted articular distal radius fractures may have less ulnar-sided wrist pain when treated with volar plate fixation compared to external fixation, according to data presented by Marc J. Richard, MD, at the annual meeting of the American Society for Surgery of the Hand.

“Ulnar-sided wrist pain is a common sequela of distal radius fractures,” said Dr. Richard. “The management of distal radius fractures has evolved, but some surgeons have suggested that the adoption of certain modern techniques may have preceded the data supporting them.

“In this study, we didn’t attempt to address the differential reasons for why people have ulnar-sided wrist pain,” he continued. “We simply compared the two techniques to see if the treatment modality made any difference in the incidence of ulnar-sided wrist pain at follow-up.”

Less pain, greater range of motion
The research team—which included Dr. Richard; Michael Miller, BS; Richard D. Goldner, MD; and David S. Ruch, MD—conducted a retrospective review of patients who had highly comminuted (AO type C2 or C3) intra-articular distal radial fractures from 1998 to 2006 and were treated at a single institution. They hoped to evaluate whether volar plate fixation correlated with a decreased incidence of ulnar-sided wrist pain. Of the 119 patients in the review, 61 were treated with bridging external fixation, and 58 were treated with volar plate fixation.

The researchers found that patients who were treated with volar plates had an average change in measured radial length of (-) 0.09 mm between the first postoperative and final follow-ups (mean 10.1 months). Patients in the external fixator group had greater radial shortening, with an average change in radial length of (-) 0.82 mm (p<0.02) at final follow-up (mean 11.7 months).>

Patients in the volar plate group also had greater arc of motion at final follow-up (169 degrees versus 142 degrees, p<0.001). fewer patients in the volar plate group had ulnar-sided wrist pain (4 of 58) compared to patients treated with an external fixator (13 of 61) (p><0.04).>

“It’s important to point out that our study didn’t examine why patients treated with external fixation have a higher incidence of pain,” stated Dr. Richard, “although we have some thoughts as to why that is. The radial shortening for example, which we measured radiographically, may lead to pain and loss of rotation.”

Given the benefits of volar plating found in this study, does external fixation still have a role as a treatment for distal radial fractures?

“Definitely,” said Dr. Richard. “In our study, which looked at fractures that were amenable to either treatment, we found more reasons to do volar plating. But there is still a role for external fixation. The personality of the fracture, associated injuries, and soft-tissue envelope all affect the choice of fixation technique.

“Complication rates are higher with external fixation than with volar plating, but some of the complications are different. Although the study didn’t address this specifically, patients treated with volar plating tend to have a higher incidence of tendon irritation on both the flexor and extensor side, which is not typically seen with external fixation. But all things being equal, volar plate fixation appears to be the better choice,” he concluded.

Dr. Richard reported no conflicts of interest.

Incidence of ulnar-sided wrist pain following treatment of intra-articular distal radius fractures with volar plate versus external fixation

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org