Locking pegs versus locking screws in volar plating of distal radius fractures

The aim of this study was to compare the radiological outcome of patients with distal radius fractures stabilized with a volar plate using either locking screws or pegs.

For this retrospective study all adult patients that received volar plating of a distal radius fracture at a trauma center between 06/2019 and 06/2022 were eligible for inclusion. Only patients who received an implant allowing both locking pegs and screws were included. Primary outcome was radiological loss of reduction at the 6-week and at the 12-month follow-up. Secondary outcomes were duration of surgery, implant removal, fracture union and complications.

Fourty-nine patients treated with pegs and 39 with screws were included. Patient demographics were comparable, however there were more complex fractures in the peg group. There was no significant difference in the occurrence of radiological loss of reduction between the groups at 6 weeks or 12 months (p = 1). Patients treated with pegs were more frequently operated upon by experienced surgeons while screws were more often used by more junior staff. The duration of surgery was longer for patients who received screws (p = 0.003). Union was achieved in all fractures for which a 12-month x-ray was available. There was no significant difference in implant removal rate or other complications.

Regarding secondary loss of reduction both locking pegs and screws show similar results. Considering the potential benefits of pegs, such as the smooth surface which may reduce the risk of joint penetration, pegs are a viable alternative to screws.