Functional and muscle strength comparison of volar plate, wrist external fixator, and closed reduction + casting in distal radius fractures

Objective: Distal radius fractures are the most common type of fracture in adults. There are many treatment options ranging from conservative treatment to surgical treatment. In this study, we compared the effectiveness of conservative treatment options, such as closed reduction and short arm casting, with surgical treatment options, such as external fixators and volar plate screw fixation, for distal radius fractures. Materials and Methods: Distal radius fractures generally occur as a result of simple falls onto the palm with the wrist and elbow joints in extension. However, more complex fractures can also occur as a result of major traumas such as falls from height, traffic accidents inside or outside of vehicles, and workplace accidents. Depending on the type of fracture and its relationship with the wrist joint, they can be treated conservatively or surgically. In our study, we compared the VAS scores at 0, 1, 3, and 6 months and the qDASH, PRWE scores, range of motion, and wrist grip strength at 6 months among 60 patients. These patients were treated with closed reduction and short arm casting (group 1), wrist external fixator (group 2), and volar plate screw fixation (group 3) from January 2022 to June 2024, all of whom had at least 6 months of follow-up, with fractures healed at 6 months. Results: The effectiveness of treatment methods for distal radius fractures varies depending on the type of fracture and the patient's needs. In our study, we compared the conservative treatment method of closed reduction and short-arm casting with the surgical options of external fixation and volar plate fixation. Our findings indicate that surgical treatment methods provide superior results, especially in early functional outcomes and pain control. Volar plate fixation yielded better results in terms of grip strength and range of motion, while external fixation proved to be an effective alternative in specific patient groups. Closed reduction and casting remain a viable option for low-risk fractures. Treatment selection should be individualized based on the patient's overall condition, fracture type, and expectations. Conclusions: The selection of the optimal treatment method for distal radius fractures should consider the type of fracture, the patient's overall condition, and functional expectations. The data from our study indicate that volar plate fixation stands out among surgical treatments, particularly in terms of functional recovery. External fixation remains a suitable option for specific patient groups, while the conservative treatment method of closed reduction and casting offers acceptable functional outcomes with a lower risk of complications. Surgical methods enable more effective management of pain and range of motion issues in the early period. However, the choice of treatment should be carefully individualized based on the patient's specific needs and fracture characteristics.