Abstract Purpose: This study is to assess the comparative effectiveness of volar locking plates versus nonlocking plates (NLPs) in the management of die-punch fractures of the distal radius. Materials and Methods: Forty patients diagnosed with closed die-punch fractures of the distal radius were admitted in Government Thoothukudi Medical College Hospital from June 2019 to July 2023. Among them, 20 individuals received treatment with NLPs, while the remaining 20 underwent treatment involving locking compression plates (LCP). A thorough examination encompassing preoperative radiographs, computed tomography scans, three-dimensional reconstructions, postoperative radiographs, and final follow-up images was done. Various radiological parameters, including palmar tilt, radial inclination, radial length, and intraarticular step, as well as functional assessments using the Mayo wrist score, were evaluated, alongside an assessment of complications done by a single blinded observer. They were all regularly involved in deciding on therapy based on radiographs of distal radius fractures. Results: The LCP group exhibited notably superior radial height (9.8 mm vs. 6.9 mm) during the bony union phase ( P < 0.001) compared to the NLP group. A higher percentage of patients (85% vs. 65%) in the LCP group achieved acceptable joint congruity (step-off <2 mm) at the final follow-up ( P < 0.034). Comparable results were noted between the groups for palmar tilt, radial inclination, and Mayo wrist score recovery during the last follow-up. A trend toward fewer overall complications (20% vs. 35%) and major complications requiring surgical interventions (4% vs. 12%) was observed in the LCP group compared to the NLP group, although these differences did not attain statistical significance ( P = 0.335, 0.374). Conclusion: Fixation of die-punch fractures using LCP resulted in significantly improved anatomical reduction and final joint congruity compared to NLP, alongside a reduction in overall and major complications.
Sriraghavan et al. (Thu,) studied this question.