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.

Institut for Hand and Plastic Surgery Vysoké nad Jizerou Dr Farského 267 512 11 Vysoké nad Jizerou Czech Republic

Teaching Hospital Motol 1st Clinic of Orthopaedic Surgery 5 Úvalu 84 150 06 Prague 5 Czech Republic

Zobrazit více v PubMed

Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am. 2008;33:691–700. PubMed

Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89:2051–2062. PubMed

Wong KK, Chan KW, Kwok TK, Mak KH. Volar fixation of dorsally displaced distal radial fracture using locking compression plate. J Orthop Surg (Hong Kong) 2005;13:153–157. PubMed

Leung F, Tu YK, Chew WY, Chow SP. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study. J Bone Joint Surg Am. 2008;90:16–22. PubMed

Lattmann T, Meier C, Dietrich M, Forberger J, Platz A. Results of volar locking plate osteosynthesis for distal radial fractures. J Trauma. 2011;70:1510–1518. PubMed

Gradl G, Wendt M, Gierer P, Beck M, Mittlmeier T. Fixation of distal radial fractures with the Targon DR nail. Oper Orthop Traumatol. 2009;21:472–483. PubMed

Tan V, Bratchenko W, Nourbakhsh A, Capo J. Comparative Analysis of Intramedullary Nail Fixation Versus Casting for Treatment of Distal Radius Fractures. J Hand Surg Am. 2012;37:460–468. PubMed

Lerch S, Sextro HG, Wilken F, Wittenberg CE. Clinical and radiological results after distal radius fracture: intramedullary locking nail versus volar locking plate osteosynthesis. Z Orthop Unfall. 2009;147:547–552. PubMed

Ilyas AM, Thoder JJ. Intramedullary fixation of displaced distal radius fractures: a preliminary report. J Hand Surg Am. 2008;33:1706–1715. PubMed

Shin EK, Jupiter JB. Current concepts in the management of distal radius fractures. Acta Chir Orthop Traumatol Cech. 2007;74:233–246. PubMed

Müller ME, Nazarian S, Koch P. Berlin Heidelberg New York: Springer-Verlag; 1987. Classification AO des fractures: les os longs.

Rüedi TP, Buckley RE, Moran CG. New York: Thieme Medical Publishers; 2007. AO Principles of Fracture Management.

Gartland JJ, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg Am. 1951;33:895–907. PubMed

Castaing J. Les fractures recentes de l’extremite inferieure du radius chez l’adulte. Rev Chir Orthop. 1964;50:581–696. PubMed

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). [corrected]. The Upper Extremity Collaborative Group (UECG) Am J Ind Med. 1996;29:602–608. Erratum in: Am J Ind Med. 1996; 30:372. PubMed

Brooks KR, Capo JT, Warburton M, Tan V. Internal fixation of distal radius fractures with novel intramedullary implants. Clin Orthop Relat Res. 2006;445:42–50. PubMed

Geerts RW, Toonen HG, van Unen JM, van Vugt R, Werre AJ. A new technique in the treatment of distal radius fractures: the Micronail”. Acta Orthop Traumatol Turc. 2011;45:85–93. PubMed

Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM. Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am. 2006;88:2687–2694. PubMed

Mehling I, Meier M, Schlör U, Krimmer H. Multidirectional palmar fixed-angle plate fixation for unstable distal radius fracture. Handchir. Mikrochir Plast Chir. 2007;39:29–33. PubMed

MacDermid JC, Richards RS, Roth JH. Distal radius fracture: a prospective outcome study of 275 patients. J Hand Ther. 2001;14:154169. PubMed

Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006;31:359–365. PubMed

Murakami K, Abe Y, Takahashi K. Surgical treatment of unstable distal radius fractures with volar locking plates. J Orthop Sci. 2007;12:134–140. PubMed

Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004;29:96–102. PubMed

Koenig KM, Davis GC, Grove MR, Tosteson AN, Koval KJ. Is early internal fixation preferred to cast treatment for well-reduced unstable distal radial fractures? J Bone Joint Surg Am. 2009;91:2086–2093. PubMed

Clayton RA, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am. 2009;91:613–619. PubMed

Mehling I, Meier M, Schlör U, Krimmer H. Multidirectional palmar fixed-angle plate fixation for unstable distal radius fracture. Handchir Mikrochir Plast Chir. 2007;39:29–33. PubMed