Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of Russia2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics169610.21823/2311-2905-1696Research ArticleFunctional and Radiographic Outcomes for Distal Radius Fractures Treated with Volar-Locked Plates and Percutaneous K-Wires: A Comparative StudyEgiazaryanKaren A.<p>Dr. Sci. (Med.), Professor</p>egkar@mail.ruhttps://orcid.org/0000-0002-6680-9334MaximovBoris I.<p>Cand. Sci. (Med.)</p>dr.borismaximov@gmail.comhttps://orcid.org/0000-0001-6761-2309AskerovArtur A.aaa-77177@mail.ruhttps://orcid.org/0000-0003-3216-2832VedernikovNikolay N.v1917@list.ruhttps://orcid.org/0000-0003-3945-0108MatvienkoMaksim I.drtraum.matvienko@yandex.ruhttps://orcid.org/0000-0003-1973-7873Pirogov Russian National Research Medical UniversityMoscow Bauman City Hospital No. 292912202127431412910202126112021Copyright © 2021, Egiazaryan K.A., Maximov B.I., Askerov A.A., Vedernikov N.N., Matvienko M.I.2021<p><strong><em>Purpose </em></strong> to evaluate and to compare radiological and functional outcomes of the volar locking plate fixation using pronator-sparing approach and K-wire fixation of distal radius fractures. <strong><em>Materials and Methods. </em></strong>We retrospectively analyzed 41 patients with distal radius fractures (27 female and 14 male) treated in the period from 2016 to 2020 using minimally invasive osteosynthesis via pronator-sparing approach. The mean age was 51 years (31-74 years). The control group consists of 37 patients (19 female and 18 male, mean age 61 years (29-76 years)), who underwent minimally invasive percutaneous K-wire fixation of distal radius fractures during the same period of time. Comparative analysis of radiographic and functional outcomes in both groups of minimally invasive osteosynthesis of distal radius fractures was carried out in the period from 1 to 6 months after the surgery. <strong><em>Results.</em></strong> Primary union of distal radius fractures was confirmed in X-rays in all patients within 6 weeks after the surgery. There were no complications in patients treated by pronator-sparing volar locking plate fixation, whereas in K-wire group we had 6 patients with complications: 4 cases (11%) superficial infection around K-wires and 2 cases (5,4%) intraoperative damage of sensitive branch of radial nerve. There were statistically significant differences in radiographic results (volar tilt, radial inclination, and radial height) between two groups: they all were better in patients treated by pronator-sparing volar locking plate fixation during the whole follow-up period (р0,01). Minimally invasive volar locking plate fixation via pronator-sparing approach also provided significantly better grip strength and range of wrist motion and forearm rotation in the early 6-month postoperative period, compared with percutaneous K-wire fixation (р0,001). <strong><em>Conclusion.</em></strong> Our study demonstrates that both techniques of minimally invasive osteosynthesis of distal radius fractures are effective and relatively safe methods of surgical treatment, but volar plating via pronator-sparing approach leads to a better reconstruction of the distal radius and better functional outcomes compared to percutaneous K-wiring.</p>minimally invasive osteosynthesisdistal radiusplate fixationvolar locking platepronator-sparing approachK-wiringмалоинвазивный остеосинтезспицевой остеосинтездистальный метаэпифиз лучевой костиволярная пластина с угловой стабильностьюнакостный остеосинтезспица Киршнера[Kashir A., O’Donnell T. A Brachioradialis Splitting Approach Sparing the Pronator Quadratus for Volar Plating of the Distal Radius. Tech Hand Up Extrem Surg. 2015;19(4):176-181. doi: 10.1097/BTH.0000000000000104.][Максимов Б.И., Пандунц А.А., Ведерников Н.Н. Возможности сохранения квадратного пронатора предплечья при хирургическом лечении переломов дистального отдела лучевой кости. Вестник национального медико-хирургического центра им. Н.И. Пирогова. 2018;13(4):49-52. doi: 10.25881/BPNMSC.2018.22.37.008.][Maksimov B.I., Pandunc A.A., Vedernikov N.N. [Opportunities of preservation of the forearm pronator with the surgical treatment of fractures of the distal radius bone]. Vestnik natsional’nogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova [Bulletin of Pirogov National Medical and Surgical Center]. 2018;13(4): 49-52. (In Russian). doi: 10.25881/BPNMSC.2018.22.37.008.][Rey P.B., Rochet S., Loisel F., Obert L. Technical note: How to spare the pronator quadratus during MIPO of distal radius fractures by using a mini-volar plate. Chir Main. 2014;33(2):95-99. doi: 10.1016/j.main.2013.12.006.][Fan J., Chen K., Zhu H., Jiang B., Yuan F., Zhu X. et al. Effect of fixing distal radius fracture with volar locking palmar plates while preserving pronator quadratus. Chin Med J (Engl). 2014;127(16):2929-2933.][Benjamin M.M., Swigler C.W. Evidence-based review of distal radius fractures. Orthop Clin North Am. 2018;49(2):211-222. doi: 10.1016/j.ocl.2017.12.001.][Arora R., Lutz M., Hennerbichler A., Krappinger D., Espen D., Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007;21(5):316-322. doi: 10.1097/BOT.0b013e318059b993.][Chaudhry H., Kleinlugtenbelt Y.V., Mundi R., Ristevski B., Goslings J.C., Bhandari M. Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis. Clin Orthop Relat Res. 2015;473(9):3017-3027. doi: 10.1007/s11999-015-4347-1.][Хоминец В.В., Ткаченко М.В., Иванов В.С., Жогина М.А., Лисин С.В., Мышкин И.А. Современные тенденции в диагностике и хирургическом лечении переломов дистального метаэпифиза лучевой кости (научный обзор). Профилактическая и клиническая медицина. 2020;2(75):34-44.][Khominets V.V., Tkachenko M.V., Ivanov V.S., Zhogina M.A., Lisin S.V., Myshkin I.A. [Сurrent tendencies in diagnostics and surgical treatment of distal radius fracture (review)]. Profilakticheskaya i klinicheskaya meditsina [Preventive and clinical medicine]. 2020;2(75):34-44. (In Russian).][Chung K.C., Spilson S.V. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908-915. doi: 10.1053/jhsu.2001.26322.][Smith D.W., Henry M.H. Volar fixed-angle plating of the distal radius. J Am Acad Orthop Surg. 2005;13(1):28-36. doi: 10.5435/00124635-200501000-00005.][Bales J.G., Stern P.J. Treatment strategies of distal radius fractures. Hand Clin. 2012;28(2):177-184. doi: 10.1016/j.hcl.2012.02.003.][Koval K., Haidukewych G.J., Service B., Zirgibel B.J. Controversies in the management of distal radius fractures. J Am Acad Orthop Surg. 2014;22(9):566-575. doi: 10.5435/JAAOS-22-09-566.][Handoll H.H., Vaghela M.V., Madhok R. Percutaneous pinning for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2007;(3):CD006080. doi: 10.1002/14651858.CD006080.pub2.][Dos Remedios C., Nebout J., Benlarbi H., Caremier E., Sam-Wing J.F., Beya R. [Pronator quadratus preservation for distal radius fractures with locking palmar plate osteosynthesis. Surgical technique]. Chir Main. 2009;28(4):224-229. (In French). doi: 10.1016/j.main.2009.04.007.][Itoh S., Yumoto M., Kanai M., Yoshida W., Yoshioka T. Significance of a Pronator Quadratus-Sparing Approach for Volar Locking Plate Fixation of Comminuted Intra-articular Fractures of the Distal Radius. Hand (N Y). 2016;11(1):83-87. doi: 10.1177/1558944715617460.][Imatani J., Noda T., Morito Y., Sato T., Hashizume H., Inoue H. Minimally invasive plate osteosynthesis for comminuted fractures of the metaphysis of the radius. J Hand Surg Br. 2005;30(2):220-225. doi: 10.1016/j.jhsb.2004.12.009.][Takada N., Otsuka T., Yamada K., Suzuki H., Hasuo T., Kondo A. et al. Minimally invasive plate osteosynthesis for distal radius fractures with a palmar locking plate. Eur J Trauma Emerg Surg. 2012;38(6):627-632. doi: 10.1007/s00068-012-0204-z.][Geissler W.B., Fernandes D. Percutaneous and limited open reduction of intra-articular distal radial fractures. Hand Surg. 2000;5(2):85-92. doi: 10.1142/s0218810400000193.][Fernandez D.L., Jupiter J.B. Fractures of the distal radius. New York: Springer-Verlag; 1996. 339 p. doi: 10.1007/978-1-4684-0478-4.][LaFontaine M., Hardy D., Delince P. Stability assessment of distal radius fractures. Injury. 1989;(20):208-210. doi: 10.1016/0020-1383(89)90113-7.][McPeak L.A., Stiers W.M., Cope D.N. Dasability evaluation following traumatic brain injury. Phys Med Rahabil Clin N Am. 2001;12(3):587-601.][Семенкин О.М. Хирургическое лечение больных с переломами дистального метаэпифиза лучевой кости. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2010;(4):84-89.][Semyonkin O.M. [Surgical treatment of patients with radial distal metaepiphysis fractures]. Vestnik travmatologii i ortopedii im. N.N. Priorova [N.N. Priorov Journal of Traumatology and Orthopedics]. 2010;(4): 84-89. (In Russian).][Xu G.Y., Qiu Y., Mao H.J. A Network Meta-analysis of Outcomes of 7 Surgical Treatments for Distal Radius Fractures. Am J Ther. 2016;23(6):e1320-e1328. doi: 10.1097/MJT.0000000000000228.][Franceschi F., Franceschetti E., Paciotti M., Cancilleri F., Maffulli N., Denaro V. Volar locking plates versus K-wire/pin fixation for the treatment of distal radial fractures: a systematic review and quantitative synthesis. Br Med Bull. 2015;115(1):91-110. doi: 10.1093/bmb/ldv015.][Costa M.L., Achten J., Rangan A., Lamb S.E., Parsons N.R. Percutaneous fixation with Kirschner wires versus volar locking-plate fixation in adults with dorsally displaced fracture of distal radius: five-year follow-up of a randomized controlled trial. Bone Joint J. 2019;101-B(8):978-983. doi: 10.1302/0301-620X.101B8.BJJ-2018-1285.R1.][Youlden D.J., Sundaraj K., Smithers C. Volar locking plating versus percutaneous Kirschner wires for distal radius fractures in an adult population: a meta-analysis. ANZ J Surg. 2019;89(7-8):821-826. doi: 10.1111/ans.14903.][Rayhack J.M. The history and evolution of percutaneous pinning of displaced distal radius fractures. Orthop Clin North Am. 1993;24(2):287-300. doi: 10.1016/S0030-5898(21)00017-1.][Kapandji A. [Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius (author’s transl)]. Ann Chir. 1976;30(11-12):903-908. (In French).][Epinette J.A., Lehut J.M., Cavenaile M., Bouretz J.C., Decoulx J. Pouteau-Colles fracture: double-closed «basket-like» pinning according to Kapandji. Apropos of a homogeneous series of 70 cases. Ann Chir Main. 1982;1(1):71-83. (In English, French). doi: 10.1016/s0753-9053(82)80047-1.][Docquier J., Soete P., Twahirwa J., Flament A. [Kapandji’s method of intrafocal nailing in Pouteau-Colles fractures]. Acta Orthop Belg. 1982;48(5):794-810. (In French).][Kerboul B., Le Saout J., Lefevre C., Miroux D., Fabre L., Le Noac’h J.F. et al. [Comparative study of 3 therapeutic methods for Pouteau Colles’ fracture. Apropos of 97 cases]. J Chir (Paris). 1986;123(6-7):428-434. (In French).][Nonnenmacher J., Kempf I. [Role of intrafocal pinning in the treatment of wrist fractures]. Int Orthop. 1988;12(2):155-162. (In French). doi: 10.1007/BF00266982.][Naidu S.H., Capo J.T., Moulton M., Ciccone W. 2nd, Radin A. Percutaneous pinning of distal radius fractures: a biomechanical study. J Hand Surg Am. 1997;22(2):252-257. doi: 10.1016/S0363-5023(97)80159-1.][Larson A.N., Rizzo M. Locking plate technology and its applications in upper extremity fracture care. Hand Clin. 2007;23(2):269-278, vii. doi: 10.1016/j.hcl.2007.02.004.][Ruch D.S., Weiland A.J., Wolfe S.W., Geissler W.B., Cohen M.S., Jupiter J.B. Current concepts in the treatment of distal radial fractures. Instr Course Lect. 2004;53:389-401.][Jupiter J.B., Marent-Huber M. Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series. J Bone Joint Surg Am. 2009;91(1):55-65. doi: 10.2106/JBJS.G.01498.][Lee D.S., Weikert D.R. Complications of Distal Radius Fixation. Orthop Clin North Am. 2016;47(2):415-424. doi: 10.1016/j.ocl.2015.09.014.][White B.D., Nydick J.A., Karsky D., Williams B.D., Hess A.V., Stone J.D. Incidence and clinical outcomes of tendon rupture following distal radius fracture. J Hand Surg Am. 2012;37(10):2035-2040. doi: 10.1016/j.jhsa.2012.06.041.][Soong M., Earp B.E., Bishop G., Leung A., Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am. 2011;93(4):328-335. doi: 10.2106/JBJS.J.00193.][Sen M.K., Strauss N., Harvey E.J. Minimally invasive plate osteosynthesis of distal radius fractures using a pronator sparing approach. Tech Hand Up Extrem Surg. 2008;12(1):2-6. doi: 10.1097/BTH.0b013e3180cac281.][Heidari N., Clement H., Kosuge D., Grechenig W., Tesch N.P., Weinberg A.M. Is sparing the pronator quadratus muscle possible in volar plating of the distal radius? J Hand Surg Eur Vol. 2012;37(5):402-406. doi: 10.1177/1753193411424706.][Cannon T.A., Carlston C.V., Stevanovic M.V., Ghiassi A.D. Pronator-sparing technique for volar plating of distal radius fractures. J Hand Surg Am. 2014;39(12):2506-2511. doi: 10.1016/j.jhsa.2014.09.011.][Lee D.Y., Park Y.J., Park J.S. A Meta-analysis of Studies of Volar Locking Plate Fixation of Distal Radius Fractures: Conventional versus Minimally Invasive Plate Osteosynthesis. Clin Orthop Surg. 2019;11(2):208-219. doi: 10.4055/cios.2019.11.2.208.][Ahsan Z.S., Yao J. The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating. Hand (N Y). 2012;7(3):276-280. doi: 10.1007/s11552-012-9420-6.][Gordon K.D., Dunning C.E., Johnson J.A., King G.J. Influence of the pronator quadratus and supinator muscle load on DRUJ stability. J Hand Surg Am. 2003;28(6):943-950. doi: 10.1016/s0363-5023(03)00487-8.][Dos Remedios C., Nebout J., Benlarbi H., Caremier E., Sam-Wing J.F., Beya R. [Pronator quadratus preservation for distal radius fractures with locking palmar plate osteosynthesis. Surgical technique]. Chir Main. 2009;28(4):224-229. (In French). doi: 10.1016/j.main.2009.04.007.][Armangil M., Bezirgan U., Başarır K., Bilen G., Demirtaş M., Bilgin S.S. The pronator quadratus muscle after plating of distal radius fractures: is the muscle still working? Eur J Orthop Surg Traumatol. 2014;24(3):335-339. doi: 10.1007/s00590-013-1193-2.][Swigart C.R., Badon M.A., Bruegel V.L., Dodds S.D. Assessment of pronator quadratus repair integrity following volar plate fixation for distal radius fractures: a prospective clinical cohort study. J Hand Surg Am. 2012;37(9):1868-1873. doi: 10.1016/j.jhsa.2012.06.005.][Mulders M.A.M., Walenkamp M.M.J., Bos F.J.M.E., Schep N.W.L., Goslings J.C. Repair of the pronator quadratus after volar plate fixation in distal radius fractures: a systematic review. Strategies Trauma Limb Reconstr. 2017;12(3):181-188. doi: 10.1007/s11751-017-0288-4.][Hershman S.H., Immerman I., Bechtel C., Lekic N., Paksima N., Egol K.A. The effects of pronator quadratus repair on outcomes after volar plating of distal radius fractures. J Orthop Trauma. 2013;27(3):130-133. doi: 10.1097/BOT.0b013e3182539333.][Chen C.Y., Lin K.C., Yang S.W., Renn J.H., Tarng Y.W. Clinical results of using minimally invasive long plate osteosynthesis versus conventional approach for extensive comminuted metadiaphyseal fractures of the radius. Arch Orthop Trauma Surg. 2015;135(3):361-367. doi: 10.1007/s00402-015-2162-5.][Максимов Б.И., Артемьев А.А. Малоинвазивный накостный остеосинтез дистального метаэпифиза лучевой кости: показания к применению и особенности методики. Вопросы реконструктивной и пластической хирургии. 2017;20(2):61-66. doi: 10.17223/1814147/60/07.][Maximov B.I., Artemiev A.A. [Minimally invasive plate osteosynthesis of distal radius fractures: indications for use and features of the method]. Voprosy rekonstruktivnoi i plasticheskoi khirurgii [Issues of Reconstructive and Plastic Surgery]. 2017;20(2):61-66. (In Russian). doi: 10.17223/1814147/60/07][Wei X.M., Sun Z.Z., Rui Y.J., Song X.J. Minimally invasive plate osteosynthesis for distal radius fractures. Indian J Orthop. 2014;48(1):20-24. doi: 10.4103/0019-5413.125483.][Максимов Б.И. Минимально инвазивный накостный остеосинтез дистального метаэпифиза лучевой кости: есть ли преимущества перед стандартной техникой? Травматология и ортопедия России. 2020;26(1): 76-84. doi: 10.21823/2311-2905-2020-26-1-76-84.][Maximov B.I. [Minimally invasive plate osteosynthesis for distal radius fractures: are there any advantages against conventional technique?] Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2020;26(1):76-84. (In Russian). doi: 10.21823/2311-2905-2020-26-1-76-84.][Zenke Y., Sakai A., Oshige T., Moritani S., Fuse Y., Maehara T. et al. Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis. J Orthop Trauma. 2011;25(7):425-431. doi: 10.1097/BOT.0b013e3182008c83.][Lebailly F., Zemirline A., Facca S., Gouzou S., Liverneaux P. Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases. Eur J Orthop Surg Traumatol. 2014;24(6):877-890. doi: 10.1007/s00590-013-1363-2.][Егиазарян К.А., Максимов Б.И., Аскеров А.А., Ведерников Н.Н., Матвиенко М.И. Спицевой остеосинтез переломов дистального метаэпифиза лучевой кости. Кафедра травматологии и ортопедии. 2021;3(45): 62-71. doi: 10.17238/issn2226-2016.2021.3.62-71.][Egiazaryan K.A., Maximov B.I., Askerov A.A., Vedernikov N.N., Matvienko M.I. [K-wire osteosynthesis of distal radius fractures]. Kafedra travmatologii i ortopedii [The department of traumatology and orthopedics]. 2021;3(45):62-71. (In Russian). doi: 10.17238/issn2226-2016.2021.3.62-71.][Oshige T., Sakai A., Zenke Y., Moritani S., Nakamura T. 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(9): 1385-1392. doi: 10.1016/j.jhsa.2007.07.005.][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(10):845-846, 848-854. (In German). doi: 10.1007/s00113-006-1163-9.][Zong S.L., Kan S.L., Su L.X., Wang B. Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires. J Orthop Surg Res. 2015;10:108. doi: 10.1186/s13018-015-0252-2.][Knox J., Ambrose H., McCallister W., Trumble T. Percutaneous pins versus volar plates for unstable distal radius fractures: a biomechanic study using a cadaver model. J Hand Surg Am. 2007;32(6):813-817. doi: 10.1016/j.jhsa.2007.03.015][Costa M.L., Achten J., Parsons N.R., Rangan A., Griffin D., Tubeuf S. et al. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial. BMJ. 2014;349:g4807. doi: 10.1136/bmj.g4807.][Costa M.L., Achten J., Plant C., Parsons N.R., Rangan A., Tubeuf S. et al. UK DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius. Health Technol Assess. 2015;19(17):1-124, v-vi. doi: 10.3310/hta19170.][McFadyen I., Field J., McCann P., Ward J., Nicol S., Curwen C. Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial. Injury. 2011;42(2):162-166. doi: 10.1016/j.injury.2010.07.236.][Poppler L.H., Moran S.L. Acute distal radioulnar joint instability: evaluation and treatment. Hand Clin. 2020;36(4):429-441. doi: 10.1016/j.hcl.2020.07.005.][Ross P.R., Chung K.C. Instability in the setting of distal radius fractures: diagnosis, evaluation and treatment. Hand Clin. 2020;36(4):417-427. doi: 10.1016/j.hcl.2020.06.002.][Im J., Kang S.J., Lee S.J. A comparative study between conservative and surgical treatments of triangular fibrocartilage complex injury of the wrist with distal radius fractures. Clin Orthop Surg. 2021;13(1):105-109. doi: 10.4055/cios20117.][Dzaja I., MacDermid J.C., Roth J., Grewal R. Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation. Can J Surg. 2013;56(6):378-384. doi: 10.1503/cjs.22712.][Rupp M., Cambon-Binder A., Alt V., Feron J.M. Is percutaneous pinning an outdated technique for distal radius fractures? Injury. 2019;(50):30-35. doi: 10.1016/j.injury.2019.03.048.]