Distal Radius Fractures Managed by Osteosynthesis Using Intramedullary Nails – Initial Information
Authors:
Martin Vlček; P. Višňa
Authors‘ workplace:
1. ortopedická klinika FN Motol, Praha, přednosta prof. MUDr. A. Sosna, DrSc.
Published in:
Rozhl. Chir., 2008, roč. 87, č. 12, s. 628-635.
Category:
Monothematic special - Original
Overview
Aim:
Prospective assessment of one-year results of distal radius osteosyntheses using the Targon® DR (Aesculap, Tuttlingen, Germany) intramedullary nail. The nail is designed for osteosynthesis of nonarticular fractures and of simple intraarticular fractures.
Material and Methods:
The prospective study includes patients with distal radius fractures, operated in the Motol Faculty Hospital Department of traumatology from May 2006 to January 2007. The study includes 16 A and C (AO classification) fractures. Functional and X-ray results were assessed at 8 weeks, 6 months and one year after the procedure. Furthermore, Gartland and Werley scores, Castaing and DASH scores were assessed. The fracure respositioning is performed under X-ray control, Kirschner wires are used for temporary stabilization. The nailing is retrograde, the nail is introduced from the processus styloideus radii region. The proximal and distal nail stabilization screws are unlocked.
Results:
The average period of X-ray healing was 8 weeks. The average radius/ulna length difference was +0.5 mm at one year after the procedure. The average radical tilt was 1.4°dorsally. The average functional results were the following: palmar flexion 65°, dorsal flexion 63°, radial duction 26°, ulnar duction 40°, pronation 88° a supination 88°. The handgrip strength was 85% of that on the other side.
Discussion:
X-ray results were superior to those when Kirshner wires transfixation was used and similar to those when locking casts were used. The study group’s functional results correspond to those presented in published studies assessing locking casts. Loss of correction and consequent dorsal radial tilt is considered the most serious complication recorded. It occurred twice, in both cases in osteoporotic conditions.
Conclusion:
The Targon DR nail is, in particular, suitable for the management of nonarticular distal radius fractures in younger patients. The miniinvasive character of the procedure is the implant’s advantage. It helps to minimize duration of immobilization and facilitates early introduction of rehabilitation. However, it does not solve the problem of osteosynthesis of the most complicated unstable extraarticular and intraarticular distal radius fractures. However, the study group assessed was small and the options for the Targon DR nail use in distal radius osteosynthesis will be studied further.
Key words:
fracture – distal radius – osteosynthesis – intramedullary nail
Sources
1. Hagino, H., Yamamoto, K., Ohshiro, H., Nakamura, T., Kishimoto, H., Nose, T. Changing incidence of hip, distal radius, an produmal humerus fractures in Tottori Prefecture. Japan Bone, 1999; 24: 256–270.
2. Letsch, R., Infanger, M., Schmidt, J., Kock, H. J. Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position. Arch. Orthop. Trauma Surg., 2003; 123(7): 333–339.
3. Owen, R. A., Melton, L. J., Johnson, K. A., Ilstrup, D. M., Riggs, B. L. Incidence of Colles‘ fractures in a North American community. Am. J. Public Health, 1982; 72: 605–607.
4. Pilz, P., Lindemann-Sperfeld, L., Winter, S., Otto, W. Distale Radiusfracturen. Trauma Berufskh, 2000; 2: 313–319.
5. van Staa, T. P., Dennison, E. M., Luefkens, H. G., Cooper, C. Epidemiology of fractures in England and Wales. Bone, 2001; 29: 517–552.
6. Shin, E. K., Jupiter, J. B. Current concepts in the management of distal radius fractures. Acta Chir. Orthop. Traumatol. Cech., 2007; 74(4): 233–246.
7. Fawzy, E. A. , Kateros, K. T., Papagelopoulos, P. J., Themistocleous, G. S., Chennangiri, R. J., Gillham, N. R. Open reduction and internal fixation of distal radial fractures using the Pi-plate. Injury, 2005; 36(2): 317–323.
8. Pilný, J., Čižmář, I., et al. Chirurgie zápěstí. Praha, Galén, 2006.
9. Kurup, H. V., Mandalia, V., Shaju, A., Beaumont, A. Bicortical K-wires for distal radius fracture fixation: how many? Acta Orthop. Belg., 2007; 73(1): 26–30.
10. Gruber, G., Bernhardt, G. A., Köhler, G., Gruber, K. Surgical treatment of distal radius fractures with an angle fixed bar palmar plating system: a single center study of 102 patients over a 2-year period. Arch. Orthop. Trauma Surg., 2006; 126(10): 680–685.
11. Krimmer, H., Pessenlehner, C., Hasselbacher, K., Meier, M., Roth, F., Meier, R. Palmar fixed angle plating systems for instable distal radius fractures. Unfallchirurg, 2004; 107(6): 460–467.
12. Mehling, I., Meier, M., Schlör, U., Krimmer, H. Multidirectional palmar fixed-angle plate fixation for unstable distal radius fracture. Handchir. Mikrochir. Plast. Chir., 2007; 39(1): 29–33.
13. Murakami, K., Abe, Y., Takahashi, K. Surgical treatment of unstable distal radius fractures with volar locking plates. J. Orthop. Sci., 2007; 12(2): 134–140.
14. Schupp, A., Tuttlies, C., Möhlig, T., Siebert, H. R. Distal radius fractures. 2.4 mm locking compression plates. Are they worth the effort? Chirurg, 2003; 74(11): 1009–1017.
15. Kumar, S., Penematsa, S., Sadri, M., Deshmukh, S. C. Can radiological results be surrogate markers of functional outcome in distal radial extra-articular fractures? Int. Orthop., 2008; 32(4): 505-509.
16. Arora, R., Lutz, M., Zimmermann, R., Krappinger, D., Gabl, M., Pechlaner, S. Limits of palmar locking-plate osteosynthesis of unstable distal radius fracture. Handchir. Mikrochir. Plast. Chir., 2007; 39(1): 34–41.
17. Chung, K. C., Watt, A. J., Kotsis, S. V., Margaliot, Z., Haase, S. C., Kim, H. M. Treatment of unstable distal radial fractures with the volar locking plating system. J. Bone Joint Surg. Am., 2006; 88(12): 2687–2694.
18. Ring, D., Prommersberger, K., Jupiter, J. B. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J. Bone Joint Surg. Am., 2005; 87 Suppl. 1(2): 195–212.
19. Singh, S., Trikha, P., Twyman, R. Superficial radial nerve damane due to Kirschner wiring od the radius. Injury, 2005; 36(2): 30–32.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2008 Issue 12
Most read in this issue
- Polycystosis of the Liver
- Malignant Melanoma Brain Metastasis – Diagnostic Difficulties
- Preoperative Mechanical Preparation of the Colon and Antibiotic Prophylaxis in Colorectal Surgery
- Distal Radius Fractures Managed by Osteosynthesis Using Intramedullary Nails – Initial Information