Volar locking plates versus K-wire/pin fixation for the treatment of distal radial fractures: a systematic review and quantitative synthesis

INTRODUCTION: Volar locking plate and Kirschner wire/pin fixations are the most commonly used methods for surgical fixation of distal radius fractures. SOURCES OF DATA: A literature search was performed using PubMed, CINAHL, Cochrane Central and Embase Biomedical databases, selecting studies comparing two or more different surgical treatments including Kirschner wire fixation and volar locking-plate fixation. This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methodological quality of all selected articles was assessed. AREAS OF AGREEMENT: A total of 14 publications (1306 patients) were included in this review, 10 of which were prospectively designed (8 randomized controlled trial). A total of 659 (50.5%) patients underwent volar locking plating (VLP group), while 647 of 1306 (49.5%) were treated with Kirschner wire/pin fixation (KW group). No differences were recorded in terms of ROM, grip strength, radiographic variables and total rate of complications. There is no clear superiority of either fixation method for the surgical management of distal radius fractures. AREAS OF CONTROVERSY: At a pooled analysis, VLP obtained statistically significant better DASH value compared to KW (18.1 ± 7.8 vs. 12.8 ± 6.4%, P = 0.026). Costs and surgical times were significantly higher for plate fixation. GROWING POINTS: Both techniques provide excellent clinical and radiographic results, without a clear superiority of either fixation method for the surgical management of distal radius fractures. RESEARCH: There is a need for more randomized trials performing standardized measurements at fixed follow-up, with results divided by subtypes of distal radius fractures.