Randomized Comparison of Volar Locking Plates and Intramedullary Nails for Unstable Distal Radius Fractures
| Autor: | Daniel L. Gaffney, Cynthia L. Emory, Beth P. Smith, Zhongyu Li, Johannes F. Plate, Ethan R. Wiesler, L. Andrew Koman, Sandeep Mannava |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Joint Instability Male Wrist Joint medicine.medical_specialty Adolescent Narcotic medicine.medical_treatment Radiography Bone Nails Locking plate law.invention Intramedullary rod Disability Evaluation Young Adult Return to Work Forearm law medicine Humans Internal fixation Orthopedics and Sports Medicine Prospective Studies Fractures Closed Range of Motion Articular Aged Aged 80 and over Pain Postoperative business.industry Middle Aged Drug Utilization Fracture Fixation Intramedullary Surgery Analgesics Opioid medicine.anatomical_structure Cohort Female Radius Fractures business Range of motion Bone Plates Follow-Up Studies |
| Zdroj: | The Journal of Hand Surgery. 40:1095-1101 |
| ISSN: | 0363-5023 |
| DOI: | 10.1016/j.jhsa.2015.02.014 |
| Popis: | Purpose To compare minimally invasive intramedullary nails (IMN) and volar locking plates (VLP) for the treatment of unstable distal radius fractures by evaluating postoperative subjective, radiographic, and functional outcomes. The hypothesis was that IMN patients would have less pain and required less pain medication in the early postoperative period and returned to work earlier than VLP patients. Methods Sixty patients with closed, displaced, unstable, extra-articular, metaphyseal fractures of the distal radius were randomized to receive a VLP or an IMN for internal fixation. Functional outcomes (Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Questionnaire), radiographic measurements (ulnar variance, radial height, inclination, and volar tilt), and range of motion were assessed until final follow-up at 2 years after surgery. Narcotic pain medication use was documented for 5 weeks following surgery. Results There were 2 groups of 30 patients with IMN (mean age, 55 ± 14 y) or VLP (mean age, 55 ± 16 y) with similar demographics and comorbidities. Patients with IMN regained extension earlier but had similar range of motion to patients with VLP at final follow-up. There was similar improvement in Michigan Hand Questionnaire, Quick Disabilities of the Arm, Shoulder, and Hand, and strength between groups. Five weeks after surgery, fewer IMN patients required narcotic pain medication (13%) than VLP patients (33%). Radiographic outcomes were similar at final follow-up. There were 3 failures with IMN versus 1 failure with VLP. All 10 employed patients with IMN returned to previous work compared with 10 of the 12 employed patients with VLP. Time to return to work was similar for both groups. Conclusions In a cohort of similar patients, IMN and VLP provided comparable improvement in functional and radiographic outcomes. Patients with IMN required less narcotic pain medication after surgery than VLP patients. Type of study/level of evidence Therapeutic II. |
| Databáze: | OpenAIRE |
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