Role of K-Wire Supplementation in Optimizing Volar Locking Plate Fixation for Intra-Articular Distal Radius Fractures – A Prospective Comparative Study

Open Access

Abstract

Background: Intra-articular distal radius fractures pose a significant challenge in achieving stable fixation and restoring optimal wrist function. While volar locking plate (VLP) fixation is widely used, concerns remain regarding secondary displacement, particularly in comminuted fractures. Supplementary K-wire fixation may enhance construct stability, yet evidence from prospective comparative studies remains limited. Aim of the study: To evaluate the efficacy of supplementary K-wire augmentation in improving radiological and functional outcomes following volar locking plate fixation of intra-articular distal radius fractures. Methods & Materials: A prospective comparative study was conducted on 80 adult patients with AO type C1–C3 distal radius fractures. Patients were randomized into two groups: VLP + K-wire (n = 40) and VLP alone (n = 40). Standardized surgical techniques were employed, and postoperative rehabilitation was uniform. Radiological outcomes (radial height, radial inclination, volar tilt, articular step-off) were assessed at six months. Functional outcomes were evaluated using DASH and PRWE scores, grip strength, and wrist range of motion. Operative parameters and complications were also recorded. Statistical significance was set at p < 0.05. Result: Baseline demographic and fracture characteristics were comparable between groups. Operative time was slightly longer in the VLP + K-wire group (68 ± 12 vs. 59 ± 11 min, p = 0.001). At six months, patients in the VLP + K-wire group demonstrated significantly better radiological outcomes, including radial height (11.8 ± 1.3 vs. 10.9 ± 1.5 mm, p = 0.004), radial inclination (22.8 ± 2.9° vs. 21.4 ± 3.0°, p = 0.006), and volar tilt (8.1 ± 2.0° vs. 6.7 ± 2.1°, p = 0.001). Functional assessment revealed superior DASH (11.2 ± 5.0 vs. 15.6 ± 5.7, p = 0.001) and PRWE scores (13.5 ± 6.1 vs. 18.0 ± 6.3, p = 0.002), higher grip strength (89% vs. 82%, p < 0.001), and improved wrist flexion and extension in the supplemented group. Complication rates were low and comparable between groups, with no statistically significant differences. Conclusion: Supplementary K-wire augmentation in volar locking plate fixation for intra-articular distal radius fractures provides superior radiological and functional outcomes without increasing complication rates. This approach may be particularly beneficial in fractures with comminution or intra-articular displacement, supporting its routine consideration in complex distal radius fracture management.