The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

A Comparative Prospective Study Between Ligamentotaxis Versus Volar Plating in Displaced Intra-articular Fractures of Distal End Radius in Adults

Document Type : RESEARCH PAPER

Authors
Mada Sai Krishna
Krishna Chaitanya Reddy Y.
Siva Sai Kumar Reddy
Govardhan Reddy G.
Department of orthopaedics, GITAM institute of medical sciences and research, Visakhapatnam, India
10.22038/abjs.2025.87939.3982
Abstract
Objectives: The objectives of the study are to compare the efficacy of external fixator/ligamentotaxis and volar plating in the treatment of displaced intra-articular distal end radius fracture by comparing the functional outcome using the Green and O’Brien score and to assess the radiological outcome of displaced intra-articular distal end radius fracture treated with external fixator/ligamentotaxis and volar plate.
Methods: This randomized study was done on 70 patients from August 2022 to May 2024 at GIMSR Medical College and Hospital. We enrolled 35 patients in the volar plating and 35 patients in the external fixation groups. Functional outcomes were assessed at 3 and 6 months using Cooney modification of Green and O’Brien scores, and radiological outcomes were evaluated using Sarmiento radiological score.
Results: By 6 months, both groups had comparable functional outcomes. The volar plating group achieved excellent results in 71.4% of cases, compared to 48.5% in the external fixation group. Radiological parameters like palmar tilt, radial shortening, and deviation showed no significant differences. Complications were similar between groups. Superficial pin tract infections were found to be common in the external fixation group and surgical site infections in the volar plating group.
Conclusion: Volar plating provided superior early functional outcomes, particularly in grip strength; however, both methods show comparable long-term results. Treatment choice should consider patient-specific factors, including bone quality and the need for early mobilization.
Level of evidence: I
Keywords
Distal radius fractures
Ligamentotaxis
Volar plating
Subjects
1.    Zhang Y. Clinical epidemiology of orthopaedic trauma. Su Y, Chen W, Wang J, Hao J, eds. Georg Thieme Verlag; 2020.
2.    Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691-7. doi: 10.1016/j.injury.2006.04.130.
3.    Shauver MJ, Yin H, Banerjee M, Chung KC. Current and future national costs to Medicare for the treatment of distal radius fracture in the elderly. J Hand Surg Am. 2011;36(8):1282-1287. doi: 10.1016/j.jhsa.2011.05.017. 
4.    Nguyen TV, Center JR, Sambrook PN, Eisman JA. Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women the dubbo osteoporosis epidemiology study. Am J Epidemiol. 2001;153(6):587-95. doi: 10.1093/aje/153.6.587.
5.    Palvanen M, Kannus P, Parkkari J, et al. The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls. Osteoporos Int. 2000;11(10):822-31. doi: 10.1007/s001980070040.
6.    Lind T, Amer M, Hagberg L. Intra-articular lesions in distal fractures of the radius in young adults: a descriptive orthoscopic study in 50 patients. J Hand Surg Br. 1997;22(5):111-115. doi: 10.1016/s0266-7681(97)80364-6.
7.    Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P, eds. Rockwood and Green's fractures in adults. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2015.
8.    Ma C, Deng Q, Pu H, et al. External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients. Bone Res. 2016:4:16017. doi: 10.1038/boneres.2016.17.
9.    Jebson PJ, Blair WF. A surgical protocol for combined internal and external fixation of complex intra-articular distal radius fractures using dorsal and volar approaches. Iowa Orthop J. 1996;16:35-38.
10.  Trumble TE, Culp R, Hanel DP, Geissler WB, Berger RA. Instructional course lectures, the American academy of orthopaedic surgeons-intra-articular fractures of the distal aspect of the radius. J Bone Joint Surg Am. 1998;80:582-600.
11.  Hozack BA, Tosti RJ. Fragment-Specific Fixation in Distal Radius Fractures. Curr Rev Musculoskelet Med. 2019;12(2):190-197. doi: 10.1007/s12178-019-09538-6.
12.  Yeh GL, Beredjiklian PK, Katz MA, Steinberg DR, Bozentka DJ. Effects of forearm rotation on the clinical evaluation of ulnar variance. J Hand Surg Am. 2001;26(6):1042-6. doi: 10.1053/jhsu.2001.26657.
13.  Stirling E, Jeffery J, Johnson N, Dias J. Are radiographic measurements of the displacement of a distal radial fracture reliable and reproducible? Bone Joint J. 2016;98-B(8):1069-73. doi: 10.1302/0301-620X.98B8.37469.
14.  Koval K, Haidukewych GJ, Zirgibel BJ. Controversies in the management of distal radius fractures. J Am Acad Orthop Surg. 2014;22(9):566-75. doi: 10.5435/JAAOS-22-09-566.
15.  Ludvigsen T, Matre K, Gudmundsdottir RS, Krukhaug Y, Dybvik EH, Fevang JM. Surgical treatment of distal radial fractures with external fixation versus volar locking plate: a multicenter randomized controlled trial. J Bone Joint Surg Am. 2021;103(5):405-414. doi: 10.2106/JBJS.20.00275.
16.  Yu X, Yu Y, Shao X, Bai Y, Zhou T. Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study. J Orthop Surg Res. 2019;14(1):271. doi: 10.1186/s13018-019-1309-4.
17.  Shukla R, Jain RK, Sharma NK, Kumar R. External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes. J Orthop Traumatol. 2014;15(4):265-70. doi: 10.1007/s10195-014-0317-8.
18.  Sharma A, Pathak S, Sandhu H, et al. Prospective randomized study comparing the external fixator and volar locking plate in intra-articular distal radius fractures: which is better? Cureus. 2020;12(2):e6849. doi: 10.7759/cureus.6849.
19.  Jeudy J, Steiger V, Boyer P, Cronier P, Bizot P, Massin P. Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation ‘versus’ locked volar plating. Injury. 2012;43(2):174-9. doi: 10.1016/j.injury.2011.05.021.
20.  Gouk CJ, Bindra RR, Tarrant DJ, Thomas MJ. Volar locking plate fixation versus external fixation of distal radius fractures: a meta-analysis. J Hand Surg Eur Vol. 2018;43(9):954-960. doi: 10.1177/1753193417743936.
21.  Fu Q, Zhu L, Yang P, Chen A. Volar locking plate versus external fixation for distal radius fractures: A meta-analysis of randomized controlled trials. Indian J Orthop. 2018;52(6):602-610. doi: 10.4103/ortho.IJOrtho_601_16.
22.  Hammer OL, Clementsen S, Hast J, Šaltytė-Benth J, Madsen JE, Randsborg PH. Volar locking plates versus augmented external fixation of intra-articular distal radial fractures: functional results from a randomized controlled trial. J Bone Joint Surg Am. 2019;101(4):311-321. doi: 10.2106/JBJS.18.00014.
23.  Rizzo M, Katt BA, Carothers JT. Comparison of locked volar plating versus pinning and external fixation in the treatment of unstable intra-articular distal radius fractures. Hand (N Y). 2008;3(2):111-117. doi: 10.1007/s11552-007-9080-0.
24.  Walenkamp MM, Bentohami A, Beerekamp MS, et al. Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strategies Trauma Limb Reconstr. 2013;8(2):67-75. doi: 10.1007/s11751-013-0169-4.
25.  Xie X, Xie X, Qin H, Shen L, Zhang C. Comparison of internal and external fixation of distal radius fractures: A meta-analysis of randomized controlled trials. Acta Orthop. 2013;84(3):286-91. doi: 10.3109/17453674.2013.792029.
26.  Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PR. External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury. 2013;44(4):409-16. doi: 10.1016/j.injury.2012.12.003.
 
 
 
 
 
The Archives of Bone and Joint Surgery
Volume 14, Issue 9
September 2026
Pages 590-596

  • Receive Date 05 May 2025
  • Revise Date 03 June 2025
  • Accept Date 23 June 2025