Treatment Outcomes for Distal Radius Fractures: A Meta-Analysis

Clinical Snapshot

Key Findings

• P Value: Significance set at p ≤ 0.05

• Effect Size: Not specified in abstract

• Primary Outcome: No significant differences between VLP and splinting, or between bracing and splinting for DASH, PRWE, or grip strength

• Nnt Or Sensitivity: Percutaneous pinning showed better PRWE scores than VLP but higher infection rates; VLP superior to bracing for functional outcomes

• Confidence Interval: Not reported

Clinical Application

All four treatment modalities are readily available in Australian healthcare settings Findings support individualised treatment decisions within Australian orthopaedic practice guidelines, with conservative management showing comparable outcomes to surgical intervention in many cases Patients with distal radius fractures, particularly relevant for Australian orthopaedic surgeons treating older adults and osteoporotic patients

Abstract

BACKGROUND: Distal radius fractures (DRFs) are among the most prevalent in upper-extremity injuries, particularly in older adults and individuals with osteoporosis. The common treatment options include surgical interventions such as volar locking plate (VLP) fixation and percutaneous pinning, as well as conservative strategies like splinting and bracing. However, the comparative effectiveness of these modalities remains unclear. This study aims to compare the functional outcomes and complication rates associated with VLP, percutaneous pinning, bracing, and splinting in the treatment of DRFs. METHODS: A systematic search of PubMed, Google Scholar, and the Cochrane Library (September 2001-February 2025) identified randomized controlled trials, prospective cohort studies, and retrospective cohort studies comparing DRF treatments. Functional outcomes and complication rates (superficial infection, malunion, nonunion, delayed union) were analyzed. Data were analyzed using Review Manager Web with significance set at p ≤ 0.05. RESULTS: Twenty-seven studies involving 3,200 patients met inclusion criteria: VLP fixation (n = 896), percutaneous pinning (n = 666), splinting (n = 718), and bracing (n = 903). No significant differences were observed between VLP and splinting or between bracing and splinting for Disabilities of the Arm, Shoulder, and Hand (DASH); Patient-Rated Wrist Evaluation (PRWE); or grip strength. Compared with VLP, percutaneous pinning demonstrated better PRWE scores but a higher infection rate. Compared with bracing, percutaneous pinning showed significantly better DASH, PRWE, and grip strength outcomes, although with substantial heterogeneity. Compared with bracing, VLP fixation yielded significantly better DASH, PRWE, and grip strength outcomes and a lower malunion rate. CONCLUSION: All 4 treatments achieved acceptable outcomes, but with key trade-offs: Percutaneous Pinning had the best functional results but a higher infection risk. VLP provided better function and lower malunion rates than bracing. Splinting and bracing were effective conservative options, often yielding results similar to VLP, but were inferior in some specific measures. The findings suggest that a perfect anatomic repair is not always necessary for a good recovery. Ultimately, the choice of treatment must be individualized, weighing the functional benefits against the risks of complications, while considering patient health factors and preferences. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

References

1. 1.Yoon, K. W., Liu, J., & Skie, M. (2026). Treatment outcomes for distal radius fractures: A meta-analysis. JBJS Reviews. https://doi.org/10.1001/jamanetworkopen.2023.54359