Systematic review and meta-analysis

The use of volar locking plate (VLP) in the fixation of fracture fragments promised a new era in the management of distal radius fracture (DRF).

To compare the patient-reported outcomes, functional outcomes, pain, and adverse events between the different periods of immobilization following open reduction and internal fixation (ORIF) of DRFs with VLP.

We searched Medline/Pubmed, Web of Science, Ovid, and CINAHL. The inclusion criteria was randomized controlled trials (RCTs) that compared different immobilization periods after ORIF of DRFs with VLP. The last search was performed on 2 June 2020. The different immobilization periods were divided into the following three groups: ≤ 1-week group, 2–3-week group, and 5–6-week group.

Seven eligible RCTs provided data on 509 patients. We found that compared to 5–6-week group, ≤ 1-week and 2–3-week groups showed a reduction in overall Patient-Reported Wrist Evaluation (PRWE) score (SMD=–0.48, 95% CI –0.73-–0.22, P<0.001; SMD=–0.69, 95% CI –0.97-–0.41, P<0.001, respectively). We also found that there were improvements in the other patient-reported outcomes including overall Disabilities of the Arm, Shoulder, and Hand (DASH) score and pain; and functional outcomes including overall grip strength and range of motion (ROM) measures in favor of ≤ 1-week and 2–3-week groups.

This systematic review and meta-analysis showed that compared to immobilization for 5 to 6 weeks after DRF repair, immobilization for ≤ 1 week or 2 to 3 weeks showed improvements in the patients-reported outcomes and functional outcomes. The differences between the three immobilization groups may not be clinically important considering the small changes as follow up progresses.

Level I of evidence