title: Volar plate versus k-wire fixation of distal radius fractures.
abstract: The optimal management of distal radius fractures remains controversial. The aim of this study was to compare the radiographic and functional outcomes of 318 patients who underwent k-wire fixation or volar plating for fractures of the distal radius. Patients were aged between 20 and 65 years and followed for a mean of 32 months. The mean values for volar tilt, radial inclination, radial length and ulnar variance were all significantly better in the volar plate group. Malunion occurred in 13.2% of patients undergoing k-wiring and 4% of patients treated with a volar plate (p<0.007). Higher values for radial inclination, radial length and volar tilt correlated with better functional outcome as measured by disabilities of the arm shoulder and hand (DASH) and patient rated wrist evaluation (PRWE) scores. Lower values for ulnar variance correlated with better functional outcome. Although volar plate treatment resulted in a superior radiological outcome, there was no evidence that this translated into a superior functional outcome (DASH 13.12 vs. 11.25, p=0.28) (PRWE 17.56 vs. 16.31, p=0.69). The k-wiring procedure remains a suitable inexpensive option for simple fractures. Volar plating should be reserved for complex fractures that cannot be reduced by closed means.
authors.affiliation: University College Hospital Galway, Galway, Ireland. Electronic address: stevobrennan@hotmail.com.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Brennan
authors.affiliation: University College Hospital Galway, Galway, Ireland.
authors.forename: Christine
authors.initials: C
authors.lastname: Kiernan
authors.affiliation: University College Hospital Galway, Galway, Ireland.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Beecher
authors.affiliation: University College Dublin, School of Mathematical Science, Dublin, Ireland.
authors.forename: Rory T
authors.initials: RT
authors.lastname: O'Reilly
authors.affiliation: University College Hospital Galway, Galway, Ireland.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Devitt
authors.affiliation: University College Hospital Galway, Galway, Ireland.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Kearns
authors.affiliation: University College Hospital Galway, Galway, Ireland.
authors.forename: Michael E
authors.initials: ME
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001864:Bone Wires; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D018737:Hand Strength; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Distal radius; Fixation; Fracture; Kirschner; Plate; Volar; Wrist; k-Wire