Volar Plate Outcomes for Distal Radius Fracture Vary Widely Across Cultural RegionsVolar Locking Plates Show Variation in Wrist Fracture Recovery
Journal of orthopaedic traumaPublished November 5, 2026Study authors: Bilodeau Robert E, Bhadouriya Rishabh S, Klinger Craig E, van der List Jelle P, Oquendo Yousi A, Hae…PubMed ↗DOI ↗Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic
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Key Takeaway
DASH, PRWE and VAS scores after volar plating for distal radius fracture vary significantly by cultural region.
This meta-analysis examined patient-reported outcomes after open reduction and internal fixation with a volar locking plate for distal radius fractures (OTA/AO 23) in adults. It pooled treatment arms reporting DASH, PRWE and VAS scores, drawing on 52 arms for DASH, 33 for PRWE and 23 for VAS.
Across all included studies, mean scores showed significant heterogeneity for each instrument. Pooled mean scores also differed significantly across cultural regions: nine regions for DASH, seven for PRWE and eight for VAS, with P < 0.01 for each comparison.
The findings suggest that outcome benchmarks established in one part of the world may not transfer directly to another. Clinicians comparing their patients' results against published norms should account for regional variation in how these questionnaires are scored and reported.
The analysis did not report effect sizes, absolute scores, follow-up duration, adverse events or funding disclosures, and the authors note no stated limitations. Evidence certainty was graded Therapeutic Level II. Because the review is descriptive in nature, the observed regional differences should not be interpreted as caused by any specific treatment or patient factor.
How this fits prior evidence
Prior coverage has addressed cost and functional comparisons in distal radius fracture care, including lower cost with non-operative treatment versus plate fixation, and a meta-analysis of 3200 patients comparing four treatments. This analysis does not compare treatments; it addresses variation in patient-reported outcome scores after volar plating across cultural regions. That extends prior work by flagging that DASH, PRWE, and VAS benchmarks may differ by region, which is relevant when interpreting functional results alongside the treatment comparisons already covered.
Researchers analyzed data from many different studies involving adults with a specific type of wrist fracture known as a distal radius fracture. They looked at how patients reported their progress using three common scales: the DASH, PRWE, and VAS. These scores help doctors understand how well a patient can use their hand and manage their pain after surgery involving a volar locking plate.
The analysis found significant differences in these scores across various cultural regions. This means that patients in different parts of the world may report their recovery and pain levels differently. Because of these differences, the results from one specific area might not apply to everyone globally.
Because the data shows such wide variation, it is important to remember that recovery experiences can vary. While the surgery is a common treatment, the way patients feel and function may depend on local factors. Patients should talk to their doctors to understand what these results mean for their specific recovery plan.
What this means for you:
Recovery scores for wrist fractures vary significantly across different cultural regions and may not be universal.
Common questions
How do doctors measure recovery after a wrist fracture?
Doctors use several tools to measure how a patient feels after surgery. These include the DASH, PRWE, and VAS scores. These tools help track how well a person can use their hand and how much pain they experience during the healing process.
Are recovery results the same for everyone with a wrist fracture?
The study found significant differences in recovery scores across many different cultural regions. This means that a patient's reported progress might look different depending on where they are treated, and results from one region may not be the same for everyone else.
OBJECTIVES: To assess patient reported outcome (PRO) heterogeneity across different cultural and geographical regions through a systematic review and meta-analysis of PROs after volar plate fixation of distal radius fractures.
DATA SOURCES: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for randomized controlled trials from 2010 to 2023 reporting Disabilities of the Arm, Shoulder, and Hand (DASH), QuickDASH, Patient-Rated Wrist Evaluation (PRWE), or Visual Analog Scale (VAS) PROs.
STUDY SELECTION: Randomized controlled trials with treatment arms consisting of open reduction and internal fixation using a volar locking plate for adult distal radius fracture (OTA/AO 23) and reported DASH, QuickDASH, PRWE, or VAS PROs were included. Studies not published in English or that provided insufficient extraction data were excluded.
DATA EXTRACTION: Studies were characterized by country of origin, continent of origin, and cultural region of origin. Extracted data included PRO outcomes, patient demographics, and follow-up ranges.
DATA SYNTHESIS: Random-effects meta-analysis was performed with restricted maximum likelihood method, and subgroup analyses were performed to determine differences in pooled PROs across geographical and cultural regions.
RESULTS: A total of 52 treatment arms met inclusion criteria for DASH analysis, 33 for PRWE, and 23 for VAS. Significant mean DASH score heterogeneity existed across all studies ( P < 0.01). Nine cultural regions were represented in the DASH analysis and demonstrated significantly different pooled mean PRO scores ( P < 0.01). Significant mean PRWE score heterogeneity existed across all studies ( P < 0.01). Seven cultural regions were represented in the PRWE analysis and demonstrated significantly different pooled mean PRO scores ( P < 0.01). Significant mean VAS score heterogeneity existed across all studies ( P < 0.01). Eight cultural regions were represented in the VAS analysis and demonstrated significantly different pooled mean PRO scores ( P < 0.01).
CONCLUSIONS: PROs after distal radius volar plate fixation demonstrated meaningful variation across cultural and geographic contexts. Outcomes from one cultural region may not be globally generalizable.
LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
