Distal Radius Osteosynthesis with Volar Locking Plate versus Dorsal Locking Plate: A Matched Comparative Cohort

Abstract Distal radius fractures (DRFs) are common injuries in orthopaedic emergency care and often require open reduction and internal fixation (ORIF) for displaced and intra-articular fractures. Volar locking plates (VLPs) and dorsal locking plates (DLPs) are widely used options, each with specific anatomical considerations and distinct complication profiles. This study aims to compare functional and radiographic outcomes and complication rates between fixation with a VLP and a DLP in the treatment of DRFs. This retrospective cohort study included patients with DRFs treated surgically between 2015 and 2021. A total of 32 patients who underwent DLP fixation were first identified. Subsequently, 32 matching VLP controls were manually selected during the same period based on age, sex, and fracture classification, resulting in a total study population of 64 patients. Functional outcomes were assessed using the Patient-Rated Wrist Evaluation (PRWE) questionnaire and the Visual Analog Scale (VAS), with a minimum follow-up of 6 months. Radiographic outcomes and complications were also analyzed. Statistical significance was set at p < 0.05. Functional outcomes (PRWE and VAS) showed no statistically significant differences between the VLP and DLP groups. Radiographic analysis demonstrated significant improvements between preoperative and postoperative parameters in both groups, with no significant differences between them. Complications occurred in 25% of patients in the VLP group and 15.6% in the DLP group, including hardware removal in 9.4% and 3.1%, respectively, with no statistical significance. Both techniques adequately restored anatomical parameters and provided satisfactory functional outcomes. Although a higher absolute frequency of complications was observed in the VLP group, the findings are consistent with the literature, suggesting comparable efficacy and safety between techniques. The choice of approach should consider fracture complexity and surgeon experience. Fixation with a VLP and a DLP demonstrated similar functional and radiographic results, with no significant differences in complication rates, supporting the use of both techniques according to patient and fracture characteristics. Therapy, Level 2b.