Restricted accessResearch articleFirst published online 2016-6
Is intramedullary nailing better than the use of volar locking plates for fractures of the distal radius? A meta-analysis of randomized controlled trials
We conducted a meta-analysis of randomized controlled trials that compared the use of intramedullary nails and volar locking plates in distal radial fractures. PubMed, EMBASE and the Cochrane Collaboration Central database were used to find randomized controlled trials that met the eligibility criteria. Two reviewers screened the studies, extracted the data, evaluated the methodological quality and analysed the data with RevMan 5.1 software. No statistically significant differences were detected in the disability of the arm, shoulder and hand and the Gartland and Werley scores, radiographic parameters, wrist range of motion, grip strength, total complication rate and incidence of tendon rupture between the two groups. However, carpal tunnel syndrome occurred less often after intramedullary nailing. The two fixation methods achieved equal clinical, functional and radiological outcomes for primary fixation of the indicated types of distal radial fractures.
BrooksKRCapoJTWarburtonMTanV.Internal fixation of distal radius fractures with novel intramedullary implants. Clin Orthop Relat Res. 2006, 445: 42–50.
2.
BurkhartKJNowakTEGradlG. Intramedullary nailing vs. palmar locked plating for unstable dorsally comminuted distal radius fractures: a biomechanical study. Clin Biomech (Bristol, Avon). 2010, 25: 771–5.
3.
ChappuisJBoutePPutzP.Dorsally displaced extra-articular distal radius fractures fixation: dorsal IM nailing versus volar plating. A randomized controlled trial. Orthop Traumatol Surg Res. 2011, 97: 471–8.
4.
ChenNCJupiterJB.Management of distal radial fractures. J Bone Joint Surg Am. 2007, 89: 2051–62.
5.
ChungKCSpilsonSV.The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001, 26: 908–15.
6.
DerSimonianRLairdN.Meta-analysis in clinical trials. Control Clin Trials. 1986, 7: 177–88.
7.
FanueleJKovalKJLurieJZhouWTostesonARingD. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009, 91: 1313–9.
8.
FullerDABarrettMMarburgerRKHirschR.Carpal canal pressures after volar plating of distal radius fractures. J Hand Surg Br. 2006, 31: 236–9.
9.
FurlanADPennickVBombardierCvan TulderM.2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976). 2009, 34: 1929–41.
10.
GartlandJJWerleyCW. Evaluation of healed Colles’ fractures. J Bone Joint Surg Am. 1951, 33-A: 895–907.
11.
GradlGMielschNWendtM. Intramedullary nail versus volar plate fixation of extra-articular distal radius-fractures. Two year results of a prospective randomized trial. Injury. 2014, 45 Suppl1: S3–8.
12.
GummessonCAtroshiIEkdahlC.The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003, 4: 11.
13.
HandollHHMadhokR.WITHDRAWN: Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2009: CD003209.
14.
HardmanJAl-HadithyNHesterTAnakweR. Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures. Int Orthop. 2015, 39: 2381–7.
15.
HigginsJPGreenS, Cochrane handbook for systematic review of interventions version 5.0.0 [updated February2008]. The Cochrane Collaboration. Available from www.cochrane-handbook.org (March 2011).
16.
HigginsJPThompsonSG.Quantifying heterogeneity in a meta-analysis. Stat Med. 2002, 21: 1539–58.
17.
HigginsJPThompsonSGDeeksJJAltmanDG.Measuring inconsistency in meta-analyses. BMJ. 2003, 327: 557–60.
18.
IlyasAMThoderJJ.Intramedullary fixation of displaced distal radius fractures: a preliminary report. J Hand Surg Am. 2008, 33: 1706–15.
19.
KarlJWOlsonPRRosenwasserMP.The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma. 2015, 29: e242–4.
20.
KonstantinidisLHelwigPSeifertJ. Internal fixation of dorsally comminuted fractures of the distal part of the radius: a biomechanical analysis of volar plate and intramedullary nail fracture stability. Arch Orthop Trauma Surg. 2011, 131: 1529–37.
21.
LerchSSextroHGWilkenFWittenbergCE.Clinical and radiological results after distal radius fracture: intramedullary locking nail versus volar locking plate osteosynthesis. Z Orthop Unfall. 2009, 147: 547–52.
22.
MantelNHaenszelW.Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959, 22: 719–48.
23.
McCallTAConradBBadmanBWrightT.Volar versus dorsal fixed-angle fixation of dorsally unstable extra-articular distal radius fractures: a biomechanic study. J Hand Surg Am. 2007, 32: 806–12.
24.
MoherDShamseerLClarkeM. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015, 4: 1.
25.
OrbayJLTouhamiA.Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res. 2006, 445: 58–67.
26.
PetscavageJMHaASKhorashadiLPerrichKChewFS.New and improved orthopedic hardware for the 21st century: part 1, upper extremity. AJR Am J Roentgenol. 2011, 197: W423–33.
27.
PlateJFGaffneyDLEmoryCL. Randomized comparison of volar locking plates and intramedullary nails for unstable distal radius fractures. J Hand Surg Am. 2015, 40: 1095–101.
28.
ProtopsaltisTSRuchDS.Volar approach to distal radius fractures. J Hand Surg Am. 2008, 33: 958–65.
29.
RampoldiMMarsicoA.Dorsal nail plate fixation of distal radius fractures. Acta Orthop Belg. 2010, 76: 472–8.
30.
RheePCShinAY.Minimally invasive flexible insertion and rigid intramedullary nail fixation for distal radius fractures. Tech Hand Up Extrem Surg. 2012, 16: 159–65.
31.
RozentalTDBlazarPE.Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006, 31: 359–65.
32.
SafiAHartRTeknedzjanBKozakT.Treatment of extra-articular and simple articular distal radial fractures with intramedullary nail versus volar locking plate. J Hand Surg Eur. 2013, 38: 774–9.
33.
TanVCapoJWarburtonM.Distal radius fracture fixation with an intramedullary nail. Tech Hand Up Extrem Surg. 2005, 9: 195–201.
34.
VlčekMJaganjacEPechJJonasDKebrleR.Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures?Bosn J Basic Med Sci. 2014, 14: 81–8.
35.
WalenkampMMBentohamiABeerekampMS. Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strategies Trauma Limb Reconstr. 2013, 8: 67–75.
36.
WangJYangYMaJ. Open reduction and internal fixation versus external fixation for unstable distal radial fractures: a meta-analysis. Orthop Traumatol Surg Res. 2013, 99: 321–31.
37.
WilckeMKAbbaszadeganHAdolphsonPY.Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year. Acta Orthop. 2011, 82: 76–81.
38.
ZehirSCalbiyikMZehirRIpekD.Intramedullary repair device against volar plating in the reconstruction of extra-articular and simple articular distal radius fractures; a randomized pilot study. Int Orthop. 2014, 38: 1655–60.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
