Volar plating remains better than cast treatment in all variables, yet still not good enough for some

IN this JBJS meta-analysis, Volar plating was superior to cast treatment in all domains at 12 months, but not enough to meet a “Minimum Clinically Important Difference (MCID)” in any.

I have a few issues with a study design like this. First, in only including “high-quality” studies of randomizing volar plating to cast treatment without other treatment arms, the authors exclude the vast majority of literature on distal radius fractures. This took the number of included studies from over 1700 down to 8. While this can help to cancel out signal noise of poorly done or irrelevant data, it is hardly representative of our collective experience with these injuries.

Second, use of a 12-month time period is an odd choice. Many prospective studies would not be able to be published without at least 2 year followup (which I think is counterproductive in trauma literature as most of these patients are lost before 2 years) in an effort to improve data quality. 12 months is not long enough to pick up on the long-term outcome differences and it is not early enough to pick up on the early benefits of surgery.

As a surgeon, I obviously think surgery works, and I admit my bias to that effect, but such an odd set of exclusion criteria seem concocted to prevent the detection of any benefits of surgery.