Volar Locking Plating of Extra-articular Distal Radius Fracture: A Retrospective Clinical Study Comparing Locking Screws versus Smooth Locking Pegs

Abstract

Background Open reduction and internal fixation of distal radius fractures is one of the most common procedures performed in wrist surgery. The use of volar locking plate has gained increasing interest in the past decade. Epiphyseal fixation can be done either with locking screws or smooth locking pegs, with no evidence supporting the use of one rather than the other.

Purpose The aim of this study is to compare the stability of distal radius fixation by volar locking plate using locking screws or smooth locking pegs.

Methods Adult patients with A2–A3 AO fractures treated with a volar plate with locking screws only or smooth locking pegs only were retrospectively included. Radiographic assessment was performed to evaluate extra-articular parameters in the intraoperative postreduction and fixation period and after bony healing. Forty-seven distal radius fractures were included.

Results Twenty-four fractures had fixation with locking screws and 23 had fixation with smooth locking pegs. For both groups, all radiographic parameters measured showed a statistically significant difference between the intraoperative postreduction and fixation period and the remote postoperative period after union of the fracture (p < 0.05) attesting a slight loss of reduction. Nevertheless, there were no significant differences between the groups in radiographic extra-articular parameters.

Conclusion This clinical study shows that there is no difference in stability fixation between locking screws or smooth locking pegs in A2–A3 distal radius fractures.

Clinical Relevance The use of smooth locking pegs only for epiphyseal fixation appears to be safe in volar plating of A2–A3 distal radius fractures in adult patients and could be an alternative to locking screws. More clinical data are needed to confirm these results.

Level of Evidence Level III; retrospective comparative study.

Keywords

distal radius fracture - extra-articular - volar locking plate - smooth locking peg - locking screw

Ethical Approval

Ethical approval was obtained from Institutional Review Board: IRB 0353-20-TLV.

Publication History

Received: 19 August 2022

Accepted: 28 June 2023

Article published online:
28 July 2023

• References

• 1 Bentohami A, Bosma J, Akkersdijk GJM, van Dijkman B, Goslings JC, Schep NWL. Incidence and characteristics of distal radial fractures in an urban population in The Netherlands. Eur J Trauma Emerg Surg 2014; 40 (03) 357-361
• 2 Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J 2014; 96-B [phone]
• 3 Stevenson I, Carnegie CA, Christie EM, Kumar K, Johnstone AJ. Displaced distal radial fractures treated using volar locking plates: maintenance of normal anatomy. J Trauma 2009; 67 (03) 612-616
• 4 Martineau PA, Waitayawinyu T, Malone KJ, Hanel DP, Trumble TE. Volar plating of AO C3 distal radius fractures: biomechanical evaluation of locking screw and locking smooth peg configurations. J Hand Surg Am 2008; 33 (06) 827-834
• 5 Downing ND, Karantana A. A revolution in the management of fractures of the distal radius?. J Bone Joint Surg Br 2008; 90 (10) 1271-1275
• 6 Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A. Removal of locked volar plates after distal radius fractures. J Hand Surg Am 2011; 36 (06) 982-985
• 7 Mehling I, Klitscher D, Mehling AP. et al. Volar fixed-angle plating of distal radius fractures: screws versus pegs–a biomechanical study in a cadaveric model. J Orthop Trauma 2012; 26 (07) 395-401
• 8 Weninger P, Dall'Ara E, Leixnering M. et al. Volar fixed-angle plating of extra-articular distal radius fractures–a biomechanical analysis comparing threaded screws and smooth pegs. J Trauma 2010; 69 (05) E46-E55
• 9 Yao J, Park MJ, Patel CS. Biomechanical comparison of volar locked plate constructs using smooth and threaded locking pegs. Orthopedics 2014; 37 (02) e169-e173
• 10 Boretto JG, Pacher N, Giunta D, Gallucci GL, Alfie V, De Carli P. Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures. J Hand Surg Eur Vol 2014; 39 (07) 755-760
• 11 Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. X-ray film measurements for healed distal radius fractures. J Hand Surg Am 1996; 21 (01) 31-39
• 12 Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004; 29 (01) 96-102
• 13 Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27 (02) 205-215
• 14 Cheng MF, Chiang CC, Lin CC, Chang MC, Wang CS. Loss of radial height in extra-articular distal radial fracture following volar locking plate fixation. Orthop Traumatol Surg Res 2021; 107 (05) 102842
• 15 Gruber G, Gruber K, Giessauf C. et al. Volar plate fixation of AO type C2 and C3 distal radius fractures, a single-center study of 55 patients. J Orthop Trauma 2008; 22 (07) 467-472
• 16 Baumbach SF, Synek A, Traxler H, Mutschler W, Pahr D, Chevalier Y. The influence of distal screw length on the primary stability of volar plate osteosynthesis–a biomechanical study. J Orthop Surg Res 2015; 10: 139
• 17 Wall LB, Brodt MD, Silva MJ, Boyer MI, Calfee RP. The effects of screw length on stability of simulated osteoporotic distal radius fractures fixed with volar locking plates. J Hand Surg Am 2012; 37 (03) 446-453
• 18 Drobetz H, Bryant AL, Pokorny T, Spitaler R, Leixnering M, Jupiter JB. Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction–a biomechanic study in a cadaveric model. J Hand Surg Am 2006; 31 (04) 615-622