JHS - 2026-04-21 - Journal Article
Volar Plating Versus Combined Plating For AO Type C Distal Radius Fracture: A Randomized Controlled Study Of 135 Patients With A 5-Year Follow-Up.
Thórdardóttir Á, Sagerfors M, Andersson J, Gavlovská H, Lundqvist E
Topics
Key Takeaway
At 5-year follow-up, volar locking plate fixation produced significantly better wrist ROM and PRWE scores than combined plating for AO Type C distal radius fractures, though differences did not reach MCID, and hardware removal was required in 64% of combined plating patients versus 30% of volar plate patients.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This RCT compared volar locking plate versus combined (volar + dorsal) plating for AO Type C distal radius fractures, assessing radiographic arthritis, ROM, grip strength, PRWE, QuickDASH, and EQ-5D at 5 years. Volar plating produced significantly better flexion, extension, radial deviation, and PRWE scores (P<0.05), but differences did not exceed MCID. Combined plating required hardware removal in 64% of patients versus 30% in the volar plate group (P<0.001), with no between-group difference in radiographic arthritis by Knirk and Jupiter classification.
Key Limitation
Differences in flexion, extension, radial deviation, and PRWE, while statistically significant, did not reach MCID, meaning the clinical magnitude of benefit from volar plating over combined plating remains uncertain for individual patients.
Original Abstract
PURPOSE
The purpose of this study was to compare the clinical and radiographic outcomes 5 years after randomization to volar plating or combined plating for surgical treatment of an AO (Arbeitsgemeinschaft für Osteosynthesefragen) type C distal radius fracture (DRF).
METHODS
A total of 150 patients were previously randomized to a volar locking plate or combined plating for treatment of an AO type C DRF with strict inclusion and exclusion criteria. All participating patients were invited for a 5-year postoperative follow-up. Radiographs, pain (visual analog scale), grip strength, and range of motion were documented, along with the Patient-Rated Wrist Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, and EuroQol 5-Dimension questionnaires. Arthritis in the radiocarpal and distal radioulnar joint was graded on radiographs by a senior radiologist according to the Knirk and Jupiter classification.
RESULTS
There were 135 patients (66 in the volar plate group and 69 in the combined plating group), corresponding to a 90% follow-up rate. Median age at follow-up was 67 years (interquartile range 57-75). There was no difference in radiographic arthritis between the two groups. The volar plate group had significantly better outcomes in flexion, extension, radial deviation, and Patient-Rated Wrist Evaluation (P < .05). There were no significant between-group differences in the Quick Disabilities of the Arm, Shoulder, and Hand, EuroQol 5-Dimension index, or EuroQol Visual Analog Scale (P > 05). Hardware removal was significantly more common in the combined plating group (64%) than in the volar plate group (30%) (P < .001).
CONCLUSIONS
Among surgically treated patients with AO type C DRF, those operated with volar plating had better clinical outcomes 5 years after surgery compared to those treated with combined plating, but the minimal clinically important difference was not reached. These findings support volar plating as the preferred method for AO type C DRFs.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic I.