Is volar locking plate superior to external fixation for distal radius fractures? A comprehensive meta-analysis

Özet

Objective: The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohortstudies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radiusfractures was to determine whether there was any evidence that one treatment was superior to theother.Methods: The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Metaanalyses(PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) wereretrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extractedthe data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. Thepublication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. Thequality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs andeleven CSs.Results: A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLPcould provide better results such as DASH scores (RCT: MD ¼ 6.12, 95%CI ¼ 12.07e0.17; CS:MD ¼ 6.43, 95%CI ¼ 12.53e0.3), ulnar variance (RCT: MD ¼ 0.81, 95%CI ¼ 1.25e0.37) and infectionrate (RCT: RR ¼ 0.25, 95%CI ¼ 0.10e0.65; CS: RR ¼ 0.15, 95%CI ¼ 0.06e0.40). There were no significantdifferences for G-W scores, VAS and grip strength between the VLP group and EF group. There wassignificantly greater loss of volar tilt (P ¼ 0.01) and radial inclination (P ¼ 0.02) in patients receiving EF,basing on the CSs.Conclusions: VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radialinclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion,pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination)and lower total complication rate and CRPS rate in CSs.