Skip to main content
SpringerLink
Log in

Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis

  • Review Article
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Aims

This study aims to compare the outcomes of intramedullary nail (IMN) and volar locking plate (VLP) fixation for treatment of extra-articular or simple intra-articular distal radius fractures.

Methods

PubMed, Embase, Medline and Cochrane Collaboration Central databases were searched for studies that compared the results of IMN and VLP fixation for the treatment of distal radius fractures up to March 2016. Stata 11.0 was used to perform the meta-analysis.

Results

Six randomized controlled trials (RCT) and two retrospective studies were included in this review, including 463 patients. No significant differences were found between two treatment methods in terms of any functional score, radiographic parameters and motion range in the late post-operative period (6, 12 and 24 months). However, IMN did better than VLP at the post-operative six weeks and three months, no matter which functional scoring system was used. The incidence of carpal tunnel syndrome (CTS) was 8.7% in the VLP group, significantly higher than that (0.8%) in the IMN group (OR, 0.183; 95%CI, 0.045–0.74). But for other complications, such as infection (OR, 0.449; 95%CI, 0.095–2.114), tendious damage (OR, 0.931; 95%CI, 0.238–3.648), tenosynovitis (OR, 0.806; 95%CI, 0.209–3.108), algodystrophy (pain) (OR, 0.795; 95%CI, 0.291–2.173) and radial nerve paraesthesia (OR, 1.8143; 95%CI, 0.834–3.942), no significant differences were found (P > 0.05).

Conclusions

Compared to VLP, IMN could provide better early postoperative functional outcomes and reduce the incidence of carpal tunnel syndrome, which could be of particular help in restoring confidence for workers with specialized manual skills to return to their prior jobs. Additionally, the conclusion should be cautiously treated, because it was reached in the context of limited amount of studies and relatively small sample size. Therefore, future studies with good design and large samples are required to verify this conclusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kopylov P, Johnell O, Redlund-Johnell I, Bengner U (1993) Fractures of the distal end of the radius in young adults: a 30-year follow-up. J Hand Surg Eur 18:45–9

    Article  CAS  Google Scholar 

  2. Singer B, McLauchlan G, Robinson C, Christie J (1998) Epidemiology of fractures in 15000 adults. Bone Joint J 80:243–248

    Article  CAS  Google Scholar 

  3. Zhang Y (2012) Clinical epidemiology of orthopedic trauma [M]. Thieme, New York

  4. Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM (2006) Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am 88:2687–2694

    PubMed  Google Scholar 

  5. Mackenney P, McQueen M, Elton R (2006) Prediction of instability in distal radial fractures. J Bone Joint Surg 88:1944–1951

    CAS  PubMed  Google Scholar 

  6. Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M (2009) A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma 23:237–242

    Article  PubMed  Google Scholar 

  7. Fu Y-C, Chien S-H, Huang P-J, Chen S-K, Tien Y-C, Lin G-T, Wang G-J (2006) Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients. J Trauma Acute Care Surg 60:330–333

    Article  Google Scholar 

  8. Atroshi I, Brogren E, Larsson G-U, Kloow J, Hofer M, Berggren A-M (2006) Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: a randomized assessor-blind clinical trial of 38 patients followed for 1 year. Acta Orthop 77:445–453

    Article  PubMed  Google Scholar 

  9. Strohm P, Müller C, Boll T, Pfister U (2004) Two procedures for Kirschner wire osteosynthesis of distal radial fractures. J Bone Joint Surg 86:2621–2628

    Article  PubMed  Google Scholar 

  10. Chung KC, Squitieri L, Kim HM (2008) Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years. J Hand Surg 33:809–819

    Article  Google Scholar 

  11. Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg 27:205–215

    Article  Google Scholar 

  12. Zettl R, Clauberg E, Nast-Kolb D, Ruchholtz S, Kühne C (2009) Volar locking compression plating versus dorsal plating for fractures of the distal radius: a prospective, randomized study. Unfallchirurg 112:712–718

    Article  CAS  PubMed  Google Scholar 

  13. Rozental TD, Beredjiklian PK, Bozentka DJ (2003) Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg Am 85:1956–1960

    Article  PubMed  Google Scholar 

  14. Johnson N, Cutler L, Dias J, Ullah A, Wildin C, Bhowal B (2014) Complications after volar locking plate fixation of distal radius fractures. Injury 45:528–533

    Article  CAS  PubMed  Google Scholar 

  15. Phadnis J, Trompeter A, Gallagher K, Bradshaw L, Elliott DS, Newman KJ (2012) Mid-term functional outcome after the internal fixation of distal radius fractures. J Orthop Surg Res 7:4

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lattmann T, Meier C, Dietrich M, Forberger J, Platz A (2011) Results of volar locking plate osteosynthesis for distal radial fractures. J Trauma Acute Care Surg 70:1510–1518

    Article  Google Scholar 

  17. Sahu A, Charalambous C, Mills S, Batra S, Ravenscroft M (2011) Reoperation for metalwork complications following the use of volar locking plates for distal radius fractures: a United Kingdom experience. Hand Surg 16:113–118

    Article  CAS  PubMed  Google Scholar 

  18. Hardman J, Al-Hadithy N, Hester T, Anakwe R (2015) Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures. Int Orthop 39:2381–2387

    Article  PubMed  Google Scholar 

  19. Jordan R, Saithna A (2015) Defining the role of intramedullary nailing for fractures of the distal radius. Bone Joint J 97-B:1370–6

    Article  CAS  PubMed  Google Scholar 

  20. Wang J, Zhang L, Ma J, Yang Y, Jia H, Ma X (2016) Is intramedullary nailing better than the use of volar locking plates for fractures of the distal radius? A meta-analysis of randomized controlled trials. J Hand Surg Eur Vol 41:543–52

    Article  CAS  PubMed  Google Scholar 

  21. Moher D, Schulz KF, Altman DG, Group C (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194

    Article  CAS  PubMed  Google Scholar 

  22. Chen J, Cui Y, Li X, Miao X, Wen Z, Xue Y, Tian J (2013) Risk factors for deep infection after total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 133:675–687

    Article  PubMed  Google Scholar 

  23. Zhu Y, Zhang F, Chen W, Liu S, Zhang Q, Zhang Y (2015) Risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. J Hosp Infect 89:82–89

    Article  CAS  PubMed  Google Scholar 

  24. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clin Res ed) 327:557–60

    Article  Google Scholar 

  25. Vlček M, Jaganjac E, Pech J, Jonáš D, Kebrle R (2014) 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 14:81–8

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lerch S, Sextro H, Wilken F, Wittenberg C (2008) Clinical and radiological results after distal radius fracture: intramedullary locking nail versus volar locking plate osteosynthesis. Z Orthop Unfall 147:547–552

    Article  Google Scholar 

  27. Aita MA, Ferreira CHV, Ibanez DS, Marquez RS, Ikeuti DH, Mota RT, Credidio MV, Fujiki EN (2014) Randomized clinical trial on percutaneous minimally invasive osteosynthesis of fractures of the distal extremity of the radius. Rev Bras Ortop (English Edition) 49:218–226

    Article  Google Scholar 

  28. Chappuis J, Boute P, Putz P (2011) Dorsally displaced extra-articular distal radius fractures fixation: dorsal IM nailing versus volar plating. A randomized controlled trial. Orthopaedics Traumatol: Surg Res 97:471–478

    CAS  Google Scholar 

  29. Plate JF, Gaffney DL, Emory CL, Mannava S, Smith BP, Koman LA, Wiesler ER, Li Z (2015) Randomized comparison of volar locking plates and intramedullary nails for unstable distal radius fractures. J Hand Surg 40:1095–1101

    Article  Google Scholar 

  30. Zehir S, Calbiyik M, Zehir R, Ipek D (2014) Intramedullary repair device against volar plating in the reconstruction of extra-articular and simple articular distal radius fractures; a randomized pilot study. Int Orthop 38:1655–1660

    Article  PubMed  PubMed Central  Google Scholar 

  31. Safi A, Hart R, Těknědžjan B, Kozák T (2013) Treatment of extra-articular and simple articular distal radial fractures with intramedullary nail versus volar locking plate. J Hand Surg Eur 38:774–779

    Article  CAS  Google Scholar 

  32. Gradl G, Mielsch N, Wendt M, Falk S, Mittlmeier T, Gierer P, Gradl G (2014) Intramedullary nail versus volar plate fixation of extra-articular distal radius fractures. Two year results of a prospective randomized trial. Injury 45:S3–S8

    Article  PubMed  Google Scholar 

  33. Lattmann T, Dietrich M, Meier C, Kilgus M, Platz A (2008) Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius. J Hand Surg 33:1135–1143

    Article  Google Scholar 

  34. Berglund LM, Messer TM (2009) Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg 17:369–377

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to S. Li and Y. Zhao of the Department of Orthopaedics, and to S. Liu and Q. Zhang of the Department of Statistics and Applications for their kind assistance.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People’s Republic of China

    Bing Zhang, Hengrui Chang, Kunlun Yu, Jiangbo Bai, Dehu Tian, Guisheng Zhang, Xinzhong Shao & Yingze Zhang

  2. Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China

    Bing Zhang, Hengrui Chang, Kunlun Yu, Jiangbo Bai, Dehu Tian, Guisheng Zhang, Xinzhong Shao & Yingze Zhang

  3. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China

    Hengrui Chang & Yingze Zhang

Authors
  1. Bing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hengrui Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kunlun Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiangbo Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dehu Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guisheng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xinzhong Shao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yingze Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yingze Zhang, Bing Zhang and Hengrui Chang designed the study; Kunlun Yu and Jiangbo Bai followed up the participants and documented the data; Bing Zhang and Guisheng Zhang analyzed and interpreted the data; Bing Zhang, Pan Hu and Xinzhong Shao wrote the manuscript, and Yingze Zhang approved the final version of the manuscript.

Corresponding author

Correspondence to Yingze Zhang.

Ethics declarations

Conflict of authors’ statement

All the authors declare that they have no competing interests, and no organization sponsored the research.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Table 1

(DOCX 14 kb)

Supplementary Table 2

(DOC 36 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, B., Chang, H., Yu, K. et al. Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis. International Orthopaedics (SICOT) 41, 2161–2169 (2017). https://doi.org/10.1007/s00264-017-3460-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-017-3460-z

Keywords

Search

Navigation