External Fixation Versus Volar Locking Plate for Unstable Intraarticular Distal Radius Fractures: A Prospective Comparative Study of the Functional Outcomes
Dr. Sabir Kumar Khadka 1*, Dr. Pashupati Chaudhary 2, Dr. Rosan Prasad Shah Kalawar 3,
Dr. Yam Bahadur Gurung 4, Dr. Ashish Kumar Pandey 5
1. Junior resident Department of Orthopedics B.P. Koirala Institute of Health Sciences Dharan, Nepal.
2. Professor and Head, Department of Orthopaedics, BPKIHS, Dharan.
3. Associate Professor, Department of Orthopaedics, BPKIHS, Dharan.
4,5. Assistant Professor, Department of Orthopaedics, BPKIHS, Dharan.
*Correspondence to: Dr. Sabir Kumar Khadka, Junior resident Department of Orthopedics B.P. Koirala Institute of Health Sciences Dharan, Nepal.
Copyright
© 2026 Dr. Sabir Kumar Khadka is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 09 April 2026
Published: 01 May 2026
DOI: https://doi.org/10.5281/zenodo.19923704
Abbreviations
AP Antero-posterior
BPKIHS B.P. Koirala Institute of Health Sciences
CRPP Closed Reduction and Percutaneous Pinning
CRPS Complex regional pain syndrome
CONSORT Consolidated standards of reporting trials
DASH Disabilities of the Arm, Shoulder and Hand
DNVD Distal neurovascular deficit
ER Emergency room
K wire Kirschner wire
OPD Out patient department
ORIF Open reducion and internal fixation
PG Post-graduate
POP Plaster of paris
RCT Randomized controlled trial
ROM Range of motion
RTA Road traffic accident
SD Standard deviation
SPSS Statistical Package for Social Sciences
UV Ulnar Variance
VAS Visual analog scale
VLP Volar Locking Plate
Introduction
Distal radius fracture is the most commonly encountered fracture of the upper extremity(1,2) accounting for approximately one sixth of all fractures seen in emergency departments.(3,4,5) While many of these fractures are simple metaphyseal fractures that can be managed through closed reduction and immobilization, approximately 50% involve the articular surface or distal radioulnar joint, necessitating more intensive treatment. The history of fractures of the distal radius re?ects the evolution of the understanding of many conditions in orthopedic trauma. The credit for recognition of the true nature of the injury is shared between Petit, Pouteau, and Colles, prior to whose writings it was believed that the injury was a carpal or distal radioulnar joint dislocation. Petit ?rst suggested in the early 18th century that these injuries might be fractures rather than dislocations but it was Pouteau (6) who ?rst recognized that injuries to the wrist from a fall on to the outstretched hand were usually fractures of the distal radius with “outward” or dorsal displacement. He recognized “inward” or volar displacement but attributed it to ulnar fracture. His meticulous observations demonstrate the knowledge that can be accrued from clinical examination. Pouteau could not defend his opinion from the scepticism of his colleagues as this article was published post humously. Added to this, little attention was paid to his views outside France. In 1847 Malgaigne (7) de?ned the injury further and stated that most fractures of the distal radius were caused by a fall on the palm of the hand and fewer by a fall on the back of the hand.
The concept of a variety of types of distal radius fractures was developed by John Rhea Barton (8) from Philadelphia, who in 1838 described “a subluxation of the wrist consequent to a fracture through the articular surface of the carpal extremity of the radius.” He described dorsal displacement of the wrist and the partial articular fracture.
Internal ?xation of distal radius fractures has long been dominated by percutaneous pinning, which was ?rst suggested for distal radius fracture treatment by Lambotte in 1907 with the use of one radial styloid pin.(9) This was followed by reports of many other techniques of multiple pinning in the middle to late 20th century.(9) Plating was ?rst popularized by Ellis.(10) In 1965. Since then, the development of initially dorsal plating and then volar locked plating has extended its indications.
In management, the primary goal is to restore the anatomical integrity and function of the joint.(11) Simple stable fracture patterns are best treated with a period of immobilization.(1,12) Many studies have associated as little as 1 mm of incongruity of the articular surface with worse outcomes, so the desire for anatomic restoration of the distal radial joint often is the rational for operative treatment. However, there is no established treatment method for unstable fractures.(1,2,12) There are numerous surgical options for the management of distal radial fractures, which include the use of percutaneous K-wire fixation, external fixation and open reduction internal fixation with volar and dorsal plates, both locking and non –locking.(12,13) Two commonly used methods of fixation are open reduction with internal fixation using plates and percutaneous pin fixation.(1,13) It is widely accepted that restoration of anatomical alignment and preservation of the articular surface facilitates to achieve early and sustained function without pain.(1,13)
External fixation, with or without percutaneous pinning, is a commonly used modality for treating fractures of distal radius and has been shown to be effective for maintaining radial length in the setting of the deforming force of the brachioradialis muscle. They are also easy to apply, can be adjusted in the office, require minimal exposure and thus avoid operative complications and leave no internal hardware to be dealt with. Disadvantages include an amiability to visualize and manually reduce intra-articular fracture fragments, inability to visualize concomitant ligamentous damage, and reduced early mobilization of the radio carpal joint. While external fixation utilizes ligamentotaxis to maintain reduction of displaced fracture fragments and is very useful for several types of fractures, it may not provide adequate reduction for severely comminuted or displaced intra-articular fractures, though the subject is highly controversial.
Internal fixation provides direct visualization and