Volar plate fixation vs. non-operative management for distal radius fractures in older adults: a meta-analysis

The aim of the study was to perform a systematic literature search and conduct a meta-analysis of studies comparing clinical and functional outcomes of open reduction with internal fixation (ORIF) using a volar plate and closed reduction with casting for distal radius fracture in older adults (≥60 years of age).

A comprehensive electronic search was done for PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases. Only randomized controlled trials (RCTs) comparing the two treatment modalities for functional and clinical outcomes were eligible to be included.

A total of 5 RCTs were included. The pooled estimates suggested reduced DASH scores (WMD 5.62; 95% CI, -8.55, -2.69) and improved grip strength [Grip strength compared to the contralateral side (%): WMD 13.07; 95% CI, 6.11, 20.02] in subjects receiving ORIF with volar plating. There were no significant differences in the range of motion of the wrist joint, pain scores, and rates of complications between the two treatment modalities. The overall quality of the included studies was moderate.

Our study indicates that older adults treated with volar plating for fracture of distal radius have better DASH scores and improved grip strengths. However, improved DASH scores may not be clinically relevant. Furthermore, there may be no difference in pain scores, ROM, and the rates of complications between the two treatment modalities. Further trials with large sample size are required to provide more robust evidence on this topic.