gms | German Medical Science

Objectives: It remains unclear as to whether the volar locking plate (VLP) is better than external fixation (EF) in the treatment of unstable distal radial fractures.This meta-analysis compared the use of VLP and EF for unstable distal radial fractures.

Methods: A systematic review of literature was carried out to identify randomized controlled trials (RCTs) using VLPs and EF for unstable distal radial fractures. Trials were performed before July 2017 and retrieved using MEDLINE, Embase, and the Cochrane library. Data extraction and quality evaluation of the trials were performed independently by two investigators. A meta-analysis was performed using STATA version 12.0.

Results and conclusion: Ten RCTs with a total of 932 patients were included. Of these, 451 were in the VLP group and 481 were in the EF group. Results showed that at 3 months (weighted mean difference [WMD] =12.13; 95% confidence intervals [95% CI]: 1.47-22.79; P<0.001) and at 6 months (WMD=5.08; 95% CI: -0.03-10.19; P<0.001), the VLP group had higher Disabilities of the arm, shoulder and hand score, but at 12 months (WMD=4.70; 95% CI: -1.95-11.35; P=0.166) the scores were comparable. As for range of motion, it was better in the VLP group at 3 months, while no difference at 6 and 12 months. Grip strength in the VLP group was significantly greater than in the EF group at 3 months (WMD=-13.60; 95% CI: -23.61--3.59; P<0.001), while no difference at 6 (WMD=-2.77; 95% CI: -11.32-5.78; P=0.526) and 12 months (WMD=-1.98; 95% CI: -7.84-3.88; P=0.507). There was no significant difference in reoperation and complication rates between the two procedures.This meta-analysis indicated that VLP use may have improved functional recovery in the early period after surgery, but the two methods showed similar levels of functional recovery at a later stage. The study is limited by the heterogeneity of the trials and should be interpreted with caution. Higher quality, multicenter RCTs with larger sample numbers are needed.