A Network Meta-analysis of Outcomes of 7 Surgical Treatments for Distal Radius Fractures

Abstract

To determinate the optimal treatment for distal radius fractures (DRF) by comparing the pin-track infection (PTI) rates in patients treated with 7 surgical techniques [bridging external fixation (EF), nonbridging EF, K-wire fixation, plaster fixation, dorsal plating, dorsal and volar plating, and volar plating]. After an exhaustive search of electronic databases for relevant published studies, high-quality randomized controlled trails were selected for the present network meta-analysis based on predefined selection criteria. Statistical analyses of the extracted data were conducted using Stata 12.0 software. After careful selection, 19 randomized controlled trails were included in our network meta-analysis and contained a combined total of 1805 subjects who underwent various surgical procedures. The network meta-analysis results showed that compared with bridging EF for treating DRF, the nonbridging EF, plaster fixation, volar plating, and dorsal and volar plating showed statistically significant differences in PTI rates. Importantly, the surface under the cumulative ranking curve values of the surgical interventions revealed that the PTI rates of plaster fixation and of dorsal and volar plating were the lowest, suggesting that these 2 surgical techniques are optimal for DRFs treatment, compared with the other methods. Our results suggest that plaster fixation and dorsal and volar plating are the best surgical treatments for DRFs compared with 5 other most common techniques. Thus, plaster fixation and dorsal and volar plating emerge as the most effective and credible treatments in consideration of PTI rates.