Abstract / Summary
Background: Distal radius fractures (DRF) constitute 14% of all extremity fractures and represent a significant therapeutic challenge, particularly intra-articular variants classified as AO Type B and C. While various operative modalities exist, head-to-head comparative data on functional and radiological outcomes across external fixation (EF), volar plating (VP), dorsal plating (DP), and combined volar-dorsal plating (VDP) remain limited. This study aimed to evaluate and compare these outcomes in operatively managed adult patients over a medium- to long-term follow-up. Materials and Methods: A retrospective, longitudinal observational study was conducted at a tertiary orthopaedic centre (Medica Super-speciality hospital, Kolkata) including 116 skeletally mature patients (age ≥18 years) with closed AO Type B and C intra-articular distal radius fractures treated operatively between 10th May 2014 to 2nd May 2022. Patients were allocated to four groups: EF (n=40), VP (n=68), DP (n=4), and VDP (n=4). Radiological outcomes were assessed using the Sarmiento’s modification of Lindstrom criteria and parametric measurements (volar tilt, radial inclination, ulnar variance, radial length). Functional outcomes were evaluated using the Mayo Wrist Score, Patient-Rated Wrist Evaluation (PRWE), and Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score at 6 weeks, 12 weeks, and 12 months. Statistical analysis was performed using SPSS v26; p < 0.05 was considered significant. Results: All 116 fractures achieved union. The mean age was 50.71 ± 14.11 years (range 23–78 years); 54.3% were male. AO Type C fractures comprised 57.8% of the cohort. At 12 months, mean Mayo Wrist Score was 78.19 ± 8.1 (11% excellent, 45% good, 41% fair, 3% poor); mean Q-DASH was 6.8 ± 6.8; and mean PRWE was 30.33 ± 17.05. Radiological assessment yielded excellent results in 75.8% and good results in 24.1% of patients. While the VP group showed superior early functional recovery at 6 and 12 weeks in dorsiflexion, palmar flexion, radial deviation, and pronation (p < 0.05), all groups converged to comparable functional outcomes at 12 months (p > 0.05). The overall complication rate was 1.7%, comprising pin-tract infection in the EF group and superficial wound infection in the VP group. Conclusion: Operative management of closed intra-articular distal radius fractures (AO Type B & C) yields satisfactory functional and radiological outcomes at 12 months irrespective of fixation method. Volar locked plating provides superior early recovery. Restoration of anatomical parameters correlates with improved functional outcomes, affirming its importance as a treatment goal. Longer-term prospective multicentre studies are warranted.