Comparative functional outcomes of distal radius fractures treated with Joshi’s external stabilization system versus volar locking plate fixation: a prospective cohort study

Background: Distal radius fractures are among the most common orthopedic injuries. Joshi’s external stabilization system (JESS) and volar locking plate fixation are widely used surgical options with differing biomechanical principles. Methods: A prospective cohort study of 94 patients with distal radius fractures was conducted. Patients underwent either JESS or volar locking plate fixation. Functional outcomes were assessed using DASH scores at 6 and 12 months and modified Mayo wrist score (MMWS) at 12 months. Results: Volar plating demonstrated superior functional outcomes, with significantly better early recovery and consistently improved scores at final follow-up. Patients treated with volar plating achieved better range of motion and grip strength. The JESS group showed gradual improvement over time but did not match the overall functional outcomes of the plating group. Pin tract infections were more common in the JESS group, whereas hardware-related complications were observed in the plating group. Conclusions: Volar locking plate fixation provides superior functional outcomes in distal radius fractures, both in early recovery and at final follow-up. While JESS remains a viable option in selected cases, volar plating should be preferred where feasible.