Fixation of intra-articular fractures of the distal radius using intramedullary nailing: a randomized trial versus palmar locking plates
| Autor: | Thomas Mittlmeier, Georg Gradl, Nadja Mielsch, Steffi S. I. Falk, Gertraud Gradl, Martina Wendt |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Wrist Joint medicine.medical_specialty Intra-Articular Fractures Palmar Plate Wrist law.invention Intramedullary rod 03 medical and health sciences Grip strength Fixation (surgical) 0302 clinical medicine law Germany medicine Humans 030212 general & internal medicine Prospective Studies Range of Motion Articular General Environmental Science 030222 orthopedics integumentary system Hand Strength business.industry Soft tissue Middle Aged Sagittal plane Surgery Fracture Fixation Intramedullary body regions medicine.anatomical_structure Treatment Outcome Fluoroscopy General Earth and Planetary Sciences Female Range of motion business Radius Fractures |
| Zdroj: | Injury. 47 |
| ISSN: | 1879-0267 |
| Popis: | Background Proposed benefits of intramedullary techniques include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial was that there is no significant difference with respect to functional outcome, pain and disability between patients treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation of intra-articular fractures of the distal radius. Methods We conducted a single-centre, prospective randomized matched-pairs trial. Patients with intraarticular distal radius fractures with metaphyseal comminution and a sagittal fracture line (AO 23 C2.1) were randomized to receive volar locking plate fixation ( n = 14) or intramedullary nailing ( n = 14). The outcome was measured on the basis of the Gartland and Werley and Castaing score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including volar tilt and ulnar variance. Clinical and radiographic assessment was performed at 8 weeks and 2 years after the operation. Results There were no significant differences between groups in terms of range of motion, grip strength or the level of pain at eight weeks. At the final follow up, patients in the nail group had regained more extension than in the plate group (98% of the unaffected side vs. 94%, this however, did not reach significance). Reduction was maintained in both groups; however volar tilt and ulnar variance were significantly better in the plate group. There was no significant difference in the complication rate between groups. Conclusion The present study suggests that intramedullary nail fixation is a reasonable alternative to volar plate fixation for the treatment of intra-articular distal radius fractures and both techniques can yield reliably good results. |
| Databáze: | OpenAIRE |
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