Evaluating Clinical and Radiological Outcomes of Ilizarov Ligamentotaxis and Volar Locked Plating in AO Type C2 and...

Soft tissue compromise, articular incongruity, and comminution make treating complex intra-articular distal radius fractures (AO types C2 and C3) very difficult. We hypothesized that volar locked plating (VLP) would provide superior clinical, radiological, and functional outcomes compared to Ilizarov ligamentotaxis in the management of AO type C2/C3 distal radius fractures.

This prospective observational study was conducted from June 2022 to May 2024 across five tertiary and teaching hospitals in Pakistan. 84 patients (aged 18-65) with AO type C2/C3 distal radius fractures were included and divided into two equal groups: Group A (Ilizarov, n = 42) and Group B (VLP, n = 42). The overall male-to-female ratio was 49:35. Baseline demographic and injury characteristics were documented to minimize potential confounding. Clinical outcomes were assessed using DASH (disabilities of the arm, shoulder, and hand) scores, grip strength (kg), and wrist range of motion (ROM), while radiological outcomes included volar tilt (°), radial height (mm), ulnar variance (mm), and articular congruity. Data were analyzed using SPSS version 26.0; independent-samples t-tests compared continuous variables (mean ± SD), and chi-square tests compared categorical variables, with significance set at p < 0.05. Follow-ups were conducted at six weeks, three months, six months, and twelve months.

At 12 months, the VLP group showed significantly better functional outcomes, with lower mean DASH scores (8.9 ± 3.5 vs. 11.6 ± 3.8; p = 0.01), improved wrist flexion/extension, and higher grip strength (35.3 ± 5.1 kg vs. 32.1 ± 5.7 kg; p = 0.02). Radiologically, volar tilt was greater in the VLP group (10.7° ± 2.1 vs. 9.6° ± 2.2; p = 0.05), while ulnar variance and radial height were similar. Five patients (11.9%) in the Ilizarov group developed pin-site infections, whereas none were observed in the VLP group (p = 0.02). Patient satisfaction was also higher with VLP (64.3% vs. 42.9%; p = 0.04).

Within the limitations of this prospective observational study, VLP appears to provide superior clinical, radiological, and patient-reported outcomes compared to Ilizarov ligamentotaxis for AO type C2/C3 distal radius fractures. The study contributes to the literature by providing comparative multi-center data from a South Asian population, highlighting both functional superiority and lower complication rates with VLP. Further randomized controlled trials are warranted to confirm these findings.