Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study

PurposeThis study aimed to compare the radiographic and functional results of Arbeitsgemeinschaftfur Osteosynthesefragen (AO) type C2/C3 fracture of distal radius between volar locking plate (VLP) and external fixation (EF).MethodsIt was a retrospective comparative study. Between January 2015 and March 2018, a total of 62/117 patients who underwent EF (23) or VLP fixation (39) for AO type C2/C3 distal radius fractures were assessed. The follow-up period was at least 12months. Gartland-Werley scale and the disabilities of the arm, shoulder, and hand (DASH) scale were used to evaluate the overall functional outcomes; wrist range of motion and grip strength were measured. The radiographic parameters included radial inclination, volar tilt, radial length, ulnar variance, and articular step-off. All of the comparisons were performed using SPSS 21.0.ResultsThe mean follow-up time was 17.1months. At final visit, VLP performed better in wrist flexion (69.7 degrees vs 62.3 degrees, p<0.001), forearm pronation (73.1 degrees vs 64.8 degrees, p=0.027) and supination (70.6 degrees vs 63.1 degrees, p=0.033) than EF, but not different with regard to other kinematic parameters. No significant difference was found between two groups, in term of Gartland-Werley or DASH score (p>0.05). The ulnar variance and articular step-off was significantly more improved in VLP than EF group, being 0.6 vs 1.6mm (p=0.002) and 0.5 vs 1.2mm (p=0.007). The overall rate of complications did not differ in both groups (28.2% vs 34.5%) (p=0.587).ConclusionsCompared to EF, VLP fixation showed better performance in wrist mobility, correction of ulnar variance, and improving articular congruence, but with the comparable overall functional outcomes and complication rate.