Regional versus general anesthesia in volar plate fixation of distal radius fractures: An AO/OTA-stratified matched-pair analysis of radiographic reduction quality.

BACKGROUND: Regional anesthesia is increasingly used for volar plate fixation of distal radius fractures and may offer advantages over general anesthesia. However, its association with radiographic reduction quality remains unclear. This study compared regional versus general anesthesia with respect to radiographic reduction quality and early clinical outcomes using an AO/OTA-stratified matched-pair design.

METHODS: This single-center, retrospective study included operatively treated distal radius fractures from January 2016 to December 2024. A strict 1:1 matched-pair cohort compared regional anesthesia (RA; axillary brachial plexus block) with general anesthesia (GA), using exact matching on AO/OTA main type (A/B/C) and nearest-neighbor matching on a propensity score including age and sex. The primary outcome was radiographic reduction quality assessed across five radiographic parameters and summarized using a composite radiographic reduction quality score (0-5). Secondary outcomes were operative time, complications, Soong grade, and wrist flexion/extension at the last documented follow-up.

RESULTS: Of 797 screened cases, 660 met inclusion criteria. The matched cohort comprised 112 pairs (A=48, B=13, C=51). In AO/OTA type A and B fractures, radiographic reduction quality did not differ between anesthesia groups. In AO/OTA type C fractures, reduction quality score was 3.96±1.26 in the RA group and 4.43±0.88 in the GA group (p = 0.021). Residual dorsal malreduction (volar tilt <0°) occurred significantly more frequently in the RA group than in the GA group (19.6% [10/51] vs 3.9% [2/51], p = 0.039). Among the remaining radiographic parameters, differences for radial inclination and radial height did not reach statistical significance (p = 0.064 and p = 0.057), whereas ulnar variance and intra-articular step-off were similar (p = 0.727 and p = 1.000). No differences were observed for any AO type in operative time, complication rate, Soong grade, or wrist motion.

CONCLUSION: In this matched-pair analysis, regional versus general anesthesia was associated with differences in reduction quality in AO/OTA type C fractures, with residual dorsal tilt occurring more frequently in the RA group. While clinical outcomes were comparable between both groups early after injury, the residual dorsal tilt in AO/OTA type C fractures could lead to adverse long-term outcomes. Larger studies should confirm whether general anesthesia should be recommended for all complex fracture patterns.

LEVEL OF EVIDENCE: Level III, Retrospective matched-pair analysis.