VOLAR VERSUS DORSAL PLATING IN CORRECTIVE OSTEOTOMY OF DISTAL RADIUS MALUNION: A META-ANALYSIS EXAMINING COMPLICATIONS, REOPERATIONS, AND HARDWARE REMOVAL RATES

The primary objective of this meta-analysis is to systematically evaluate and compare complication, reoperation, and hardware removal rates between volar and dorsal plating in the context of corrective osteotomy for dorsally-angulated distal radius malunions. An extensive search across the MEDLINE, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases was conducted to identify studies reporting outcomes following corrective osteotomy for dorsally-angulated distal radius malunions. Coprimary outcomes included: the occurrence of major complications, minor complications, reoperation, and hardware removal rates. Meta-analysis comparing each outcome with further meta-regression model based on surgical approach to compare the odds for each outcome was built. A total of 403 patients were included; 253 patients underwent volar corrective osteotomy and 150 underwent dorsal corrective osteotomy. Mean follow-up was 30 months. Volar plating was associated with fewer reoperations (9% vs. 28%), less hardware removal (3% vs. 18%) and comparable major complications (5% vs. 6%) compared to dorsal plating. The adjusted model showed a significant reduction (approximately 85%) in the odds of reoperation and hardware removal in the volar group. There was no difference in major or minor complications between the groups. This study shows that volar plating for dorsally angulated distal radial osteotomy significantly reduces the odds of reoperation and hardware removal compared to dorsal plating, even after careful adjustment for potential confounders.