Treatment of distal radial fractures: a current review of evidence-based results in the literature

In the treatment of distal radial fractures a trend to more surgical interventions can currently be observed, and specifically to the use of fixed-angle locking plates. Numerous publications with varying results make it difficult to formulate any general recommendations for clinical procedure. Articles on the treatment of distal radial fractures were systematically retrieved, searched for content, and classified by evidence level. Within seven Cochrane reviews some evidence could be found for better anatomical reconstruction with surgical procedures, but not for superior clinical results. Of the 64 articles retrieved on fixed-angle plates, most reported on biomechanical cadaver studies or reproduced expert opinions. Twenty-five case series were identified, in which the comments on locking plates were predominantly positive and critical comments were rare. Only three comparative studies were found, which demonstrated some advantages for fixed-angle plates in terms of radiological healing but no clinical benefit. The published data are characterised by a low level of evidence and significant clinical heterogeneity, so that they do not allow clear clinical recommendations on the treatment of distal radial fractures. In particular there was insufficent evidence to confirm the superiority of fixed angle plates.