Research Article| Volume 42, ISSUE 2, P162-166, February 2011

Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial


      Fractures of the distal radius are commonly treated with cast immobilisation; however, those potentially unstable injuries with dorsal comminution may need operative intervention. This intervention is usually with manipulation and Kirschner wires but advances in locking-plate technology have enabled surgeons to achieve anatomical reconstruction of complex fracture patterns, even in poor-quality osteoporotic bone.
      To ascertain if fixed-angle volar-locked plates confer a significant benefit over manipulation and Kirschner-wire stabilisation, we prospectively randomised 56 adult patients with isolated, closed, unilateral, unstable extra-articular fractures into two treatment groups, one fixed with K-wires and the other fixed with a volar locking plate.
      Functional outcomes were assessed using Gartland and Werley and Disabilities of the Arm, Shoulder and Hand (DASH) scores. These were statistically better in the plate group at 3 and 6 months. Radiological assessment showed statistically better results at 6 weeks, 3 months and 6 months, post-operatively. In the plate group, there was no significant loss of fracture reduction.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abbaszadegan H.
        • Jonsson U.
        • von Sivers K.
        Prediction of instability of Colles’ fractures.
        Acta Orthop Scand. 1989; 60: 646-650
        • Adolphson P.
        • Abbaszadegan H.
        • Jonsson U.
        Computer-assisted prediction of the instability of Colles’ fractures.
        Int Orthop. 1993; 17: 13-15
        • Arora R.
        • Lutz M.
        • Fritz D.
        • et al.
        Palmar locking plate for treatment of unstable dorsal dislocated distal radius fractures.
        Arch Orthop Trauma Surg. 2005; 125: 399-404
        • Arora R.
        • Lutz M.
        • Hennerbichler A.
        • et al.
        Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate.
        Orthop Trauma. 2007; 21: 316-322
        • Beaton D.E.
        • Wright J.G.
        • Katz J.N.
        Upper extremity collaborative group. QuickDASH: the comparison of three item-reduction approaches.
        J Bone Joint Surg Am. 2005; 87: 1038-1046
        • Chung K.C.
        • Watt A.J.
        • Kotsis S.V.
        • et al.
        Treatment of unstable distal radial fractures with the volar locking plating system.
        J Bone Joint Surg [Am]. 2006; 88-A: 2687-2694
        • Cohen J.
        A coefficient for agreement for nominal scales.
        Educ Psychol Meas. 1960; 20: 37-46
        • Colles A.
        On the fracture of the carpal extremity of the radius.
        Edinburgh Med Surg J. 1814; 10: 181
        • Downing N.D.
        • Karantana A.
        A revolution in the management of fractures of the distal radius?.
        J Bone Joint Surg [Br]. 2008; 90-B: 1271-1275
        • Freeland A.E.
        • Luber K.T.
        Biomechanics and biology of plate fixation of distal radius fractures.
        Hand Clin. 2005; 21: 329-339
        • Gartland J.J.
        • Werley C.W.
        Evaluation of healed Colles’ fractures.
        J Bone Joint Surg Am. 1951; 33: 895-907
        • Gummesson C.
        • Ward M.M.
        • Atroshi I.
        The shortened disabilities of the arm, shoulder and hand questionnaire (quickDASH): validity and reliability based on responses within the full-length DASH.
        BMC Musculoskelet Disord. 2006; 7: 44
        • Handoll H.H.
        • Vaghela M.V.
        • Madhok R.
        Percutaneous pinning for treating distal radius fractures in adults.
        Cochrane Database Syst Rev. 2007; 18: CD006080
        • Henry M.H.
        Distal radius fractures: current concepts.
        J Hand Surg. 2008; 33A: 1215-1227
        • Hove L.M.
        • Solheim E.
        • Skjeie R.
        • Sorensen F.K.
        Prediction of secondary displacement in Colles’ fracture.
        J Hand Surg [Br]. 1994; 19: 731-736
        • Jenkins N.H.
        • Mintowt-Czyz W.J.
        Mal-union and dysfunction in Colles. fracture.
        J Hand Surg [Br]. 1988; 13: 291-293
        • Jeong G.K.
        • Kaplan F.T.
        • Liporace F.
        • et al.
        An evaluation of two scoring systems to predict instability in fractures of the distal radius.
        J Trauma. 2004; 57: 1043-1047
        • Knox J.
        • Ambrose H.
        • McCallister W.
        • Trumble T.
        Percutaneous pins versus volar plates for unstable distal radius fractures: a biomechanical study using a cadaver model.
        J Hand Surg [Am]. 2007; 32: 813-817
        • Koval K.
        • Harrast J.
        • Anglen J.
        • Weinstein J.
        Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence?.
        J Bone Joint Surg [Am]. 2008; 90-A: 1855-1861
        • Kreder H.J.
        • Hanel D.P.
        • McKee M.
        • et al.
        Consistency of AO fracture classification for the distal radius.
        J Bone Joint Surg Br. 1996; 78: 726-731
        • Lafontaine M.
        • Hardy D.
        • Delince P.
        Stability assessment of distal radius fractures.
        Injury. 1989; 20: 208-210
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 3: 159-174
        • Lattmann T.
        • Dietrich M.
        • Meier C.
        • et al.
        Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius.
        J Hand Surg [Am]. 2008; 33: 1135-1143
        • Leone J.
        • Bhandari M.
        • Adili A.
        • et al.
        Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures.
        Acta Orthop Trauma Surg. 2004; 124: 38-41
        • Leung F.
        • Zhu L.
        • Ho H.
        • et al.
        Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate—a biomechanical study in a cadaveric model.
        J Hand Surg [Br]. 2003; 28: 263-266
        • Levin S.M.
        • Nelson C.O.
        • Botts J.D.
        • et al.
        Biomechanical evaluation of volar locking plates for distal radius fractures.
        Hand (NY). 2008; 3: 55-60
        • Liporace F.A.
        • Gupta S.
        • Jeong G.K.
        • et al.
        A biomechanical comparison of a dorsal 3. 5-mm T-plate and a volar fixed-angle plate in a model of dorsally unstable distal radius fractures.
        J Orthop Trauma. 2005; 19: 187-191
        • Mackenney P.J.
        • McQueen M.M.
        • Elton R.
        Prediction of instability in distal radial fractures.
        J Bone Joint Surg Am. 2006; 88: 1944-1951
        • Maschke S.D.
        • Evans P.J.
        • Schub D.
        • et al.
        Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study.
        Hand (NY). 2007; 2: 144-150
        • McQueen M.M.
        Non-spanning external fixation of the distal radius.
        Hand Clin. 2005; 21: 375-380
        • McQueen M.
        • Caspers J.
        Colles fracture: does the anatomical result affect the final function?.
        J Bone Joint Surg [Br]. 1988; 70-B: 649-651
        • Musgrave D.S.
        • Idler R.S.
        Volar fixation of dorsally displaced distal radius fractures using the 2.4 mm locking compression plates.
        J Hand Surg [Am]. 2005; 30: 743-749
        • Naidu S.H.
        • Capo J.T.
        • Moulton M.
        • et al.
        Percutaneous pinning of distal radius fractures: a biomechanical study.
        J Hand Surg [Am]. 1997; 22: 252-257
        • O’Neill T.W.
        • Cooper C.
        • Finn J.D.
        • et al.
        Incidence of distal forearm fracture in British men and women.
        Osteoporosis Int. 2001; 12: 555-558
        • Orbay J.L.
        • Fernandez D.L.
        Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report.
        J Hand Surg [Am]. 2002; 27: 205-215
        • Orbay J.L.
        • Fernandex D.L.
        Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient.
        J Hand Surg [Am]. 2004; 29: 96-102
        • Orbay J.L.
        • Touhami A.
        Current concepts in volar fixed-angle fixation of unstable distal radius fractures.
        Clin Orthop Relat Res. 2006; 445: 58-67
        • Osada D.
        • Tamai K.
        • Iwamoto A.
        • et al.
        Dorsal plating for comminuted intra-articular fractures of the distal end of the radius.
        Hand Surg. 2004; 9: 181-190
        • Oshige T.
        • Sakai A.
        • Zenke Y.
        • et al.
        A comparative study of clinical and radiological outcomes of dorsally angulated, unstable distal radius fractures in elderly patients: intrafocal pinning versus volar locking plating.
        J Hand Surg [Am]. 2007; 32: 1385
        • Pennig D.
        • Gausepohl T.
        External fixation of the wrist.
        Injury. 1996; 27: 1-15
        • Putnam M.D.
        • Meyer N.J.
        • Nelson E.W.
        • et al.
        Distal radial metaphyseal forces in an extrinsic grip model: implications for postfracture rehabilitation.
        J Hand Surg [Am]. 2000; 25: 469-475
        • Rozenthal T.D.
        • Blazar P.E.
        Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius.
        J Hand Surg [Am]. 2006; 31: 359-365
        • Simic P.M.
        • Robison J.
        • Gardner M.J.
        • et al.
        Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment.
        J Hand Surg [Am]. 2006; 31: 382-386
        • Soong M.
        • Got C.
        • Katarincic J.
        • Akelman E.
        Fluoroscopic evaluation of intra-articular screw placement during locked volar plating of the distal radius: a cadaveric study.
        J Hand Surg Am. 2008; 33: 1720-1723
        • Thomas A.D.
        • Greenberg J.A.
        Use of fluoroscopy in determining screw overshoot in the dorsal distal radius: a cadaveric study.
        J Hand Surg Am. 2009; 34: 258-261
        • Voigt C.
        • Lill H.
        What advantages does volar plate fixation have over K-wire fixation for distal radius extension fractures in the elderly?.
        Unfallchirurg. 2006; 109 (pp. 845–46, 848–54)
        • Willis A.A.
        • Kutsumi K.
        • Zobitz M.E.
        • Cooney W.P.
        Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability.
        J Bone Joint Surg Am. 2006; 88: 2411-2417
        • Wright T.W.
        • Horodyski M.
        • Smith D.W.
        Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation.
        J Hand Surg [Am]. 2005; 30: 289-299