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Outcomes of Arthroscopic-Assisted Distal Radius Fracture Volar Plating: A Meta-Analysis

  • Zaid Shihab
    Correspondence
    Corresponding author: Zaid Shihab, MD, MS, Department of Musculoskeletal Services, Gold Coast University Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215, Australia.
    Affiliations
    Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, Queensland, Australia
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  • Brahman Sivakumar
    Affiliations
    Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Queensland, Australia

    Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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  • David Graham
    Affiliations
    Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, Queensland, Australia

    Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Queensland, Australia

    Griffith University School of Medicine and Dentistry, Southport, Queensland, Australia

    Departmemt of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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  • Francisco del Piñal
    Affiliations
    Private Practice, Madrid and Santander, Spain
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Published:February 12, 2022DOI:https://doi.org/10.1016/j.jhsa.2021.11.025

      Purpose

      The use of wrist arthroscopy to assist fixation of distal radius fractures with volar locking plates (VLPs) has been gaining popularity in recent years; however, there is no consensus on its benefits. This meta-analysis compares outcomes of arthroscopic-assisted VLP to fluoroscopic-assisted VLP in distal radius fractures through a systematic review of the published literature.

      Methods

      A systematic search of publications from databases (Medline, EMBASE, Scopus, and Cochrane) was obtained from inception to May 2020. A random-effects meta-analysis was used to calculate effect sizes. Outcomes included postoperative radiographic reduction (gap, stepoff, radial inclination, volar tilt, and ulnar variance), procedural outcomes (operative time, additional soft tissue injuries and complications), and functional outcomes (range of motion; visual analog scale score; Disabilities of the Arm, Shoulder, and Hand score; Patient-Rated Wrist Evaluation score; Mayo clinic score; and grip strength).

      Results

      Six studies, involving 280 patients, met the final inclusion criteria. The meta-analysis for postoperative stepoff was statistically significant, favoring arthroscopic-assisted VLP. In addition, there was greater identification of associated soft tissue injuries, increased wrist extension, and a longer operative duration when performing arthroscopic-assisted VLP fixation. There were no differences in other postoperative radiographic outcomes, complications, or functional outcomes.

      Conclusions

      The current literature suggests that arthroscopic-assisted VLP is a useful adjunct to intra-articular reduction and treatment of associated soft tissue injuries in distal radius fractures. Considerations should include operative time, costs, and the additional training required. Further studies are needed to assess functional outcomes.

      Type of study/level of evidence

      Therapeutic II.

      Key words

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