Similar outcomes between IM nailing & volar plating for distal radius fractures

Study Type: Meta analysis
OE Level of Evidence: 2
Journal Level of Evidence: 2
Five randomized controlled trials (RCTs) were included in this systematic review and meta-analysis comparing clinical, functional, and radiographic outcomes between volar locking plates (VLP) and intramedullary nails (IMN) in the management of distal radius fractures. Additionally, the incidence of postoperative development of carpal tunnel syndrome was compared between techniques. No significant differences Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Tianjin Municipal Health Bureau; National Natural Science Foundation of China
Conflicts: None disclosed
Why was this study needed now?
Given the incidence at which fractures of the distal radius occur, it is important to identify the optimal management strategy for these fractures through high-quality research. In cases where surgery is indicated, volar locking plates have emerged as a gold standard option for fixation. Since the introduction of intramedullary nailing as an alternative fixation method, a few small randomized controlled trials have been performed comparing outcomes between the two operative techniques. A meta-analysis was needed to synthesize the evidence from these preliminary trials to determine if one method of surgical treatment provided advantages over another in the treatment of distal radius fractures.
What was the principal research question?
In the fixation of unstable extra-articular and simple intra-articular distal radius fractures, are there any significant differences between intramedullary nail fixation and volar locking plate fixation with respect to functional outcome, range of motion, or radiographical results?
Data Source: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for relevant articles published up to May 2015.
Index Terms: Search terms adapted from "distal radius fracture and "intramedullary" were used for each electronic database.
Study Selection: Eligibility criteria included: a randomized controlled trial design; enrolled patients with AO/OTA type A1-3, B1-2, and C1-2 fractures of the distal radius; allocated patients to either intramedullary nail fixation or volar locking plate fixation; and followed-up patients for a minimum of 6 months. The selection of studies was performed independently by two reviewers, with disagreement resolved by consensus or, if necessary, consultation with a third reviewer. A total of 5 RCTs, with data sampled from 369 patients, were selected for final inclusion.
Data Extraction: A standardized data extraction table was used independently by two reviewers, and final tables were double-checked by two additional reviewers. The primary outcomes of interest were (1) DAHS, G-W score and (2) radiographic parameters, ROM, grip strength, and complications.
Data Synthesis: Statistical analysis was performed using Review Manager Software (RevMan 5.1). Continuous outcomes were expressed as mean differences, and dichotomous outcomes as risk ratios, both with associated 95% confidence intervals. Heterogeneity was used using the Q-test and I-squared (I^2)statistic, with values of p<0.10 and 50% for the tests, respectively, considered indicative of significant heterogeneity. When heterogeneity was significant, a random-effects model was used. When heterogeneity was not significant, a fixed-effects model was used. Sensitivity analysis was performed using the leave-on-out method.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.