"Is the effect of intraoperative 3D imaging beneficial in plate fixation of distal radius fractures: a matched-pair analysis".

backgroundDistal radius fractures (DRFs) are among the most common adult fractures and are frequently treated with volar plate fixation. While intraoperative 3D imaging has been proposed to improve detection of malreduction and implant malposition, its impact on clinical and radiological outcomes remains unclear. This study aimed to evaluate whether intraoperative 3D imaging provides advantages over conventional 2D fluoroscopy. Outcome criteria were accuracy of fracture reduction, plate positioning relative to the watershed line, complication rates, operative time, and functional outcomes following volar plate fixation of distal radius fractures.

methodsThis retrospective single-centre study included patients aged ≥ 16 years who underwent volar plate fixation for distal radius fractures between 2016 and 2024. Patients were assigned to a 3D imaging group or a conventional 2D fluoroscopy group. To ensure comparability, patients were matched 1:1 using exact AO/OTA subgroup matching and propensity score matching for age and sex. Outcomes included operative duration, radiographic reduction quality, plate positioning, complications, and wrist range of motion. Matched-pair comparisons were performed using appropriate paired statistical tests.

resultsOf 1,259 patients screened, 418 patients (209 matched pairs) were included after exact AO/OTA subgroup matching and propensity score matching for age and sex. Operative time was significantly longer in the 3D group across AO type A, B, and C fractures (all p < 0.05), with the largest difference observed in complex C3 fractures. Reduction quality was comparable in AO type A fractures, whereas higher reduction scores were observed in the 3D group for AO type B fractures and complex C3 fractures. No significant differences were observed in plate positioning, complication rates, or wrist range of motion between groups.

conclusionIntraoperative 3D imaging was associated with longer operative times than conventional 2D fluoroscopy and did not improve plate positioning, complication rates, or short-term wrist range of motion. While reduction quality was comparable in simple fracture patterns, exploratory analyses demonstrated higher reduction scores in AO type B and complex intra-articular C3 fractures treated with 3D imaging. These findings suggest that the potential benefit of intraoperative 3D imaging may be concentrated in selected complex fracture patterns rather than routine distal radius fracture fixation. Prospective studies are required to confirm these findings.