Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures?

Martin Vlček,Edib Jaganjac,Radek Kebrle,David Jonáš

doi:10.17305/bjbms.2014.2268

Abstract

Can minimally invasive intramedullary osteosynthesis of distal radius fractures provide better therapeutic results than multidirectional locking plates. Retrospective study of 68 patients operated for distal radius fractures, 18 were treated with intramedullary X-screw (XSCR) fixation and 50 with the multidirectional angle-stable plate system (APTUS). The evaluation at 1-year follow-up included functional status of the wrist and hand, and radiographic findings. In the XSCR group, the functional outcomes of the treated extremity did not achieve values comparable with those of the uninjured side in any of the parameters measured. The radiographic findings did not meet the requirements of successful healing due to failure to restore an anatomical volar tilt in 22.2% cases. In the APTUS group, comparable values of the injured and the uninjured side were achieved in radial deviation, ulnar deviation, pronation, supination and grip strength. The radiographic criteria of successful healing were met by all fractures treated by locking plate osteosynthesis. Implant migration associated with secondary displacement of bone fragments was recorded in 33.3 % of the XSCR patients and only in 4.0 % of the APTUS patients. The overall evaluation show that intramedullary osteosynthesis does not produce better treatment outcomes compared with plate osteosynthesis in indicated types of fractures.

Highlights

Fractures of the distal radius are complex injuries with varied prognosis depending on the type of fracture and method of treatment [ ].There is still no clinical evidence suggesting a superior modality for their management [ ]
Ilyas et al [ ] have reported that using the intramedullary nail (Micronail, Wright Medical Technologies, Arlington, TN, U.S.A.) in the treatment of displaced distal radius fractures can result in good functional outcome, but is associated with a high incidence of complications, i.e., screw penetration into the distal radioulnar joint, and transient superficial radial sensory neuritis
Radiographic findings Radiographs obtained at a one-year follow-up showed complete bony union in all fractures of both groups

Summary

Introduction

Fractures of the distal radius are complex injuries with varied prognosis depending on the type of fracture and method of treatment [ ].There is still no clinical evidence suggesting a superior modality for their management [ ]. Angle-stable fixation provides sufficient stability of the fracture to allow early start of rehabilitation soon after surgery; the total treatment time is shorter and good functional outcomes are achieved even in unstable grossly comminuted intra-articular fractures [ , ]. Intramedullary osteosynthesis is used for fragment fixation less frequently and good radiographic and functional outcomes have been published [ ]. Ilyas et al [ ] have reported that using the intramedullary nail (Micronail, Wright Medical Technologies, Arlington, TN, U.S.A.) in the treatment of displaced distal radius fractures can result in good functional outcome, but is associated with a high incidence of complications, i.e., screw penetration into the distal radioulnar joint, and transient superficial radial sensory neuritis,. Since for surgical stabilization to all types of distal radius fractures multidirectional angle-stable plates

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Conclusion