Martina Wendt

Intramedullary nail versus volar plate fixation of extra-articular distal radius fractures. Two year results of a prospective randomized trial

BACKGROUND Intramedullary techniques for stabilization of displaced distal radius fractures are now available. Purported benefits include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial is 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 unstable dorsally displaced extra-articular fractures of the distal radius. METHODS We conducted a single-centre, parallel-group trial, with unrestricted randomization. Patients with dorsally displaced extra-articular distal radius fractures were randomized to receive volar locking plate (n=72) fixation or intramedullary nailing (n=80). 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, 6 months, 1 year 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 during the entire follow-up period (p>0.05). There was no significant difference between treatment groups with respect to volar tilt or ulnar variance (p>0.05). There was no significant difference in the complication rate between groups (p>0.05). CONCLUSIONS The present study supports the view that intramedullary nail fixation and volar plate fixation for the treatment of displaced extra-articular distal radius fractures have equivalent radiographic and functional outcomes. LEVEL OF EVIDENCE Level I therapeutic study.

Fixation of intra-articular fractures of the distal radius using intramedullary nailing: a randomized trial versus palmar locking plates

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.

Fixation of distal radial fractures with the Targon DR nail

OBJECTIVE Anatomic restoration and intramedullary fixation of distal radial fractures using a hybrid between plate and nail (Targon DR). The technique provides a less invasive operative approach from radial. INDICATIONS Extraarticular fractures of the distal radius with dorsal comminution. Intraarticular fractures without displacement and with a sagittal fracture line. CONTRAINDICATIONS Flexion fractures, intraarticular fractures with displacement of the articular surface or a frontal fracture line. SURGICAL TECHNIQUE 4-cm skin incision from the tip of the radial styloid. Careful dissection of the superficial branch of the radial nerve. Preparation of the bone between first and second extensor compartment. Reduction of the fracture, insertion of a Kirschner wire from the tip of the styloid across the fracture line. Opening of the intramedullary canal with a cannulated drill using the Kirschner wire as a guide. Stepwise widening of the intramedullary canal with profilers. Implantation of the Targon DR device. Interlocking using an aiming jig. Replacement of Kirschner wires by screws, removal of the aiming jig, and wound closure. POSTOPERATIVE MANAGEMENT Palmar splint for 2-14 days. Immediate functional after treatment. Full weight bearing 6 weeks after surgery. RESULTS From December 2006 to May 2008, 103 patients were treated with a Targon DR nail. 95 patients experienced the 8-week follow-up, 50 patients the 1-year follow-up. The mean time for surgery was 41.7 +/- 6.1 min. All fractures united. Radiologic analysis revealed a mean palmar tilt of 2.05 degrees +/- 0.67 degrees , radial length in relation to the ulna was adequately restored (0.06 +/- 0.05 mm difference compared to the uninjured side). As soon as 8 weeks after surgery the arc of extension/flexion reached 80% of the uninjured side. Mean Gartland-Werley Score 1 year after surgery was excellent (1.53 +/- 0.41).ZusammenfassungOperationszielAusheilung einer dislozierten distalen Radiusfraktur in anatomischer Position durch geschlossene oder offene Reposition und winkelstabile Osteosynthese unter Verwendung eines intramedullären Nagels.IndikationenExtraartikuläre Extensionsfrakturen des distalen Radius (AO 23 A3).Intraartikuläre Frakturen ohne Dislokation der Gelenkfläche und mit sagittalem Frakturverlauf.KontraindikationenFlexionsfrakturen, dislozierte Gelenkfrakturen und Gelenkfrakturen mit Frakturverlauf in der frontalen Ebene.OperationstechnikZugang über einen 4 cm langen radialen Hautschnitt über dem Processus styloideus radii. Darstellung und Schonung des Ramus superficialis nervi radialis. Eingehen auf den Knochen zwischen erstem und zweitem Strecksehnenfach. Reposition der Fraktur, Einbringen eines Kirschner- Drahts über den Processus styloideus radii und Überbohren des Kirschner-Drahts mit einem Hohlbohrer. Schrittweise Erweiterung des Markraums über Raffeln. Einbringen des Implantats. Anschließend temporäre Verriegelung mit Kirschner-Drähten über einen Zielbügel. Ersetzen der Kirschner-Drähte durch Schrauben und Entfernen des Zielinstrumentariums. Hautverschluss.WeiterbehandlungTemporäre Behandlung mit Unterarmgipsschiene für 2–14 Tage. Beginn mit frühfunktioneller Behandlung ab dem 1. postoperativen Tag. Belastungssteigerung bis zur Vollbelastung 6 Wochen postoperativ.ErgebnisseVon Dezember 2006 bis Mai 2008 wurden 103 Patienten mit einem Targon DR versorgt. Der Nachuntersuchung nach 8 Wochen sind 95 Patienten nachgekommen, 1-Jahres-Werte liegen von 50 Patienten vor. Die mittlere Operationszeit betrug 41,7 ± 6,1 min. Alle Frakturen heilten. Die radiologische Auswertung zeigte eine mittlere Palmarinklination von 2,05° ± 0,67°. Gute Rekonstruktion der radialen Länge in Relation zur Ulna (0,06 ± 0,05 mm Differenz zur unverletzten Gegenseite). Bereits 8 Wochen postoperativ waren bei Extension/Flexion 80% der Gegenseite erreicht. Der mittlere Gartland-Werley-Score 1 Jahr postoperativ war mit 1,53 ± 0,41 Punkten exzellent.AbstractObjectiveAnatomic restoration and intramedullary fixation of distal radial fractures using a hybrid between plate and nail (Targon DR). The technique provides a less invasive operative approach from radial.IndicationsExtraarticular fractures of the distal radius with dorsal comminution.Intraarticular fractures without displacement and with a sagittal fracture line.ContraindicationsFlexion fractures, intraarticular fractures with displacement of the articular surface or a frontal fracture line.Surgical Technique4-cm skin incision from the tip of the radial styloid. Careful dissection of the superficial branch of the radial nerve. Preparation of the bone between first and second extensor compartment. Reduction of the fracture, insertion of a Kirschner wire from the tip of the styloid across the fracture line. Opening of the intramedullary canal with a cannulated drill using the Kirschner wire as a guide. Stepwise widening of the intramedullary canal with profilers. Implantation of the Targon DR device. Interlocking using an aiming jig. Replacement of Kirschner wires by screws, removal of the aiming jig, and wound closure.Postoperative ManagementPalmar splint for 2–14 days. Immediate functional aftertreatment. Full weight bearing 6 weeks after surgery.ResultsFrom December 2006 to May 2008, 103 patients were treated with a Targon DR nail. 95 patients experienced the 8-week follow-up, 50 patients the 1-year follow-up. The mean time for surgery was 41.7 ± 6.1 min. All fractures united. Radiologic analysis revealed a mean palmar tilt of 2.05° ± 0.67°, radial length in relation to the ulna was adequately restored (0.06 ± 0.05 mm difference compared to the uninjured side). As soon as 8 weeks after surgery the arc of extension/flexion reached 80% of the uninjured side. Mean Gartland-Werley Score 1 year after surgery was excellent (1.53 ± 0.41).

Die Versorgung distaler Radiusfrakturen mit dem Targon DR®-Nagel

OBJECTIVE Anatomic restoration and intramedullary fixation of distal radial fractures using a hybrid between plate and nail (Targon DR). The technique provides a less invasive operative approach from radial. INDICATIONS Extraarticular fractures of the distal radius with dorsal comminution. Intraarticular fractures without displacement and with a sagittal fracture line. CONTRAINDICATIONS Flexion fractures, intraarticular fractures with displacement of the articular surface or a frontal fracture line. SURGICAL TECHNIQUE 4-cm skin incision from the tip of the radial styloid. Careful dissection of the superficial branch of the radial nerve. Preparation of the bone between first and second extensor compartment. Reduction of the fracture, insertion of a Kirschner wire from the tip of the styloid across the fracture line. Opening of the intramedullary canal with a cannulated drill using the Kirschner wire as a guide. Stepwise widening of the intramedullary canal with profilers. Implantation of the Targon DR device. Interlocking using an aiming jig. Replacement of Kirschner wires by screws, removal of the aiming jig, and wound closure. POSTOPERATIVE MANAGEMENT Palmar splint for 2-14 days. Immediate functional after treatment. Full weight bearing 6 weeks after surgery. RESULTS From December 2006 to May 2008, 103 patients were treated with a Targon DR nail. 95 patients experienced the 8-week follow-up, 50 patients the 1-year follow-up. The mean time for surgery was 41.7 +/- 6.1 min. All fractures united. Radiologic analysis revealed a mean palmar tilt of 2.05 degrees +/- 0.67 degrees , radial length in relation to the ulna was adequately restored (0.06 +/- 0.05 mm difference compared to the uninjured side). As soon as 8 weeks after surgery the arc of extension/flexion reached 80% of the uninjured side. Mean Gartland-Werley Score 1 year after surgery was excellent (1.53 +/- 0.41).ZusammenfassungOperationszielAusheilung einer dislozierten distalen Radiusfraktur in anatomischer Position durch geschlossene oder offene Reposition und winkelstabile Osteosynthese unter Verwendung eines intramedullären Nagels.IndikationenExtraartikuläre Extensionsfrakturen des distalen Radius (AO 23 A3).Intraartikuläre Frakturen ohne Dislokation der Gelenkfläche und mit sagittalem Frakturverlauf.KontraindikationenFlexionsfrakturen, dislozierte Gelenkfrakturen und Gelenkfrakturen mit Frakturverlauf in der frontalen Ebene.OperationstechnikZugang über einen 4 cm langen radialen Hautschnitt über dem Processus styloideus radii. Darstellung und Schonung des Ramus superficialis nervi radialis. Eingehen auf den Knochen zwischen erstem und zweitem Strecksehnenfach. Reposition der Fraktur, Einbringen eines Kirschner- Drahts über den Processus styloideus radii und Überbohren des Kirschner-Drahts mit einem Hohlbohrer. Schrittweise Erweiterung des Markraums über Raffeln. Einbringen des Implantats. Anschließend temporäre Verriegelung mit Kirschner-Drähten über einen Zielbügel. Ersetzen der Kirschner-Drähte durch Schrauben und Entfernen des Zielinstrumentariums. Hautverschluss.WeiterbehandlungTemporäre Behandlung mit Unterarmgipsschiene für 2–14 Tage. Beginn mit frühfunktioneller Behandlung ab dem 1. postoperativen Tag. Belastungssteigerung bis zur Vollbelastung 6 Wochen postoperativ.ErgebnisseVon Dezember 2006 bis Mai 2008 wurden 103 Patienten mit einem Targon DR versorgt. Der Nachuntersuchung nach 8 Wochen sind 95 Patienten nachgekommen, 1-Jahres-Werte liegen von 50 Patienten vor. Die mittlere Operationszeit betrug 41,7 ± 6,1 min. Alle Frakturen heilten. Die radiologische Auswertung zeigte eine mittlere Palmarinklination von 2,05° ± 0,67°. Gute Rekonstruktion der radialen Länge in Relation zur Ulna (0,06 ± 0,05 mm Differenz zur unverletzten Gegenseite). Bereits 8 Wochen postoperativ waren bei Extension/Flexion 80% der Gegenseite erreicht. Der mittlere Gartland-Werley-Score 1 Jahr postoperativ war mit 1,53 ± 0,41 Punkten exzellent.AbstractObjectiveAnatomic restoration and intramedullary fixation of distal radial fractures using a hybrid between plate and nail (Targon DR). The technique provides a less invasive operative approach from radial.IndicationsExtraarticular fractures of the distal radius with dorsal comminution.Intraarticular fractures without displacement and with a sagittal fracture line.ContraindicationsFlexion fractures, intraarticular fractures with displacement of the articular surface or a frontal fracture line.Surgical Technique4-cm skin incision from the tip of the radial styloid. Careful dissection of the superficial branch of the radial nerve. Preparation of the bone between first and second extensor compartment. Reduction of the fracture, insertion of a Kirschner wire from the tip of the styloid across the fracture line. Opening of the intramedullary canal with a cannulated drill using the Kirschner wire as a guide. Stepwise widening of the intramedullary canal with profilers. Implantation of the Targon DR device. Interlocking using an aiming jig. Replacement of Kirschner wires by screws, removal of the aiming jig, and wound closure.Postoperative ManagementPalmar splint for 2–14 days. Immediate functional aftertreatment. Full weight bearing 6 weeks after surgery.ResultsFrom December 2006 to May 2008, 103 patients were treated with a Targon DR nail. 95 patients experienced the 8-week follow-up, 50 patients the 1-year follow-up. The mean time for surgery was 41.7 ± 6.1 min. All fractures united. Radiologic analysis revealed a mean palmar tilt of 2.05° ± 0.67°, radial length in relation to the ulna was adequately restored (0.06 ± 0.05 mm difference compared to the uninjured side). As soon as 8 weeks after surgery the arc of extension/flexion reached 80% of the uninjured side. Mean Gartland-Werley Score 1 year after surgery was excellent (1.53 ± 0.41).

Treatment of extra-articular distal radius fractures with the Targon DR Nail (intramedullary fixation)

In this prospective study 82 patients at the mean age of 65 years (range 17 to 91 years) were treated with the Targon DR. Inclusion criteria were extra-articular A3 fractures. All patients were treated by closed reduction and intramedullary nailing using the Targon DR nail. The major outcome of this study was that intramedullary fixation with a hybrid between plate and nail comes along with excellent functional outcome and very low pain. The minimally invasive technique allows anatomical restoration and safe reduction permitting an early range of motion. At follow up of 1 year all patients had a functioning joint and resumed their previous activities. In x-ray analysis all fractures united with a reconstructed articular facet without any steps. There was no secondary loss of reduction by treatment with the Targon DR nail. We had no cases of hardware failures, tendon irritation or tendon rupture. The Targon DR is competitive in terms of fracture reduction, maintenance of reduction and functional outcome.

Die Versorgung distaler Radiusfrakturen mit dem Targon DR®-Nagel@@@Fixation of Distal Radial Fractures with the Targon DR® Nail

OBJECTIVE Anatomic restoration and intramedullary fixation of distal radial fractures using a hybrid between plate and nail (Targon DR). The technique provides a less invasive operative approach from radial. INDICATIONS Extraarticular fractures of the distal radius with dorsal comminution. Intraarticular fractures without displacement and with a sagittal fracture line. CONTRAINDICATIONS Flexion fractures, intraarticular fractures with displacement of the articular surface or a frontal fracture line. SURGICAL TECHNIQUE 4-cm skin incision from the tip of the radial styloid. Careful dissection of the superficial branch of the radial nerve. Preparation of the bone between first and second extensor compartment. Reduction of the fracture, insertion of a Kirschner wire from the tip of the styloid across the fracture line. Opening of the intramedullary canal with a cannulated drill using the Kirschner wire as a guide. Stepwise widening of the intramedullary canal with profilers. Implantation of the Targon DR device. Interlocking using an aiming jig. Replacement of Kirschner wires by screws, removal of the aiming jig, and wound closure. POSTOPERATIVE MANAGEMENT Palmar splint for 2-14 days. Immediate functional after treatment. Full weight bearing 6 weeks after surgery. RESULTS From December 2006 to May 2008, 103 patients were treated with a Targon DR nail. 95 patients experienced the 8-week follow-up, 50 patients the 1-year follow-up. The mean time for surgery was 41.7 +/- 6.1 min. All fractures united. Radiologic analysis revealed a mean palmar tilt of 2.05 degrees +/- 0.67 degrees , radial length in relation to the ulna was adequately restored (0.06 +/- 0.05 mm difference compared to the uninjured side). As soon as 8 weeks after surgery the arc of extension/flexion reached 80% of the uninjured side. Mean Gartland-Werley Score 1 year after surgery was excellent (1.53 +/- 0.41).ZusammenfassungOperationszielAusheilung einer dislozierten distalen Radiusfraktur in anatomischer Position durch geschlossene oder offene Reposition und winkelstabile Osteosynthese unter Verwendung eines intramedullären Nagels.IndikationenExtraartikuläre Extensionsfrakturen des distalen Radius (AO 23 A3).Intraartikuläre Frakturen ohne Dislokation der Gelenkfläche und mit sagittalem Frakturverlauf.KontraindikationenFlexionsfrakturen, dislozierte Gelenkfrakturen und Gelenkfrakturen mit Frakturverlauf in der frontalen Ebene.OperationstechnikZugang über einen 4 cm langen radialen Hautschnitt über dem Processus styloideus radii. Darstellung und Schonung des Ramus superficialis nervi radialis. Eingehen auf den Knochen zwischen erstem und zweitem Strecksehnenfach. Reposition der Fraktur, Einbringen eines Kirschner- Drahts über den Processus styloideus radii und Überbohren des Kirschner-Drahts mit einem Hohlbohrer. Schrittweise Erweiterung des Markraums über Raffeln. Einbringen des Implantats. Anschließend temporäre Verriegelung mit Kirschner-Drähten über einen Zielbügel. Ersetzen der Kirschner-Drähte durch Schrauben und Entfernen des Zielinstrumentariums. Hautverschluss.WeiterbehandlungTemporäre Behandlung mit Unterarmgipsschiene für 2–14 Tage. Beginn mit frühfunktioneller Behandlung ab dem 1. postoperativen Tag. Belastungssteigerung bis zur Vollbelastung 6 Wochen postoperativ.ErgebnisseVon Dezember 2006 bis Mai 2008 wurden 103 Patienten mit einem Targon DR versorgt. Der Nachuntersuchung nach 8 Wochen sind 95 Patienten nachgekommen, 1-Jahres-Werte liegen von 50 Patienten vor. Die mittlere Operationszeit betrug 41,7 ± 6,1 min. Alle Frakturen heilten. Die radiologische Auswertung zeigte eine mittlere Palmarinklination von 2,05° ± 0,67°. Gute Rekonstruktion der radialen Länge in Relation zur Ulna (0,06 ± 0,05 mm Differenz zur unverletzten Gegenseite). Bereits 8 Wochen postoperativ waren bei Extension/Flexion 80% der Gegenseite erreicht. Der mittlere Gartland-Werley-Score 1 Jahr postoperativ war mit 1,53 ± 0,41 Punkten exzellent.AbstractObjectiveAnatomic restoration and intramedullary fixation of distal radial fractures using a hybrid between plate and nail (Targon DR). The technique provides a less invasive operative approach from radial.IndicationsExtraarticular fractures of the distal radius with dorsal comminution.Intraarticular fractures without displacement and with a sagittal fracture line.ContraindicationsFlexion fractures, intraarticular fractures with displacement of the articular surface or a frontal fracture line.Surgical Technique4-cm skin incision from the tip of the radial styloid. Careful dissection of the superficial branch of the radial nerve. Preparation of the bone between first and second extensor compartment. Reduction of the fracture, insertion of a Kirschner wire from the tip of the styloid across the fracture line. Opening of the intramedullary canal with a cannulated drill using the Kirschner wire as a guide. Stepwise widening of the intramedullary canal with profilers. Implantation of the Targon DR device. Interlocking using an aiming jig. Replacement of Kirschner wires by screws, removal of the aiming jig, and wound closure.Postoperative ManagementPalmar splint for 2–14 days. Immediate functional aftertreatment. Full weight bearing 6 weeks after surgery.ResultsFrom December 2006 to May 2008, 103 patients were treated with a Targon DR nail. 95 patients experienced the 8-week follow-up, 50 patients the 1-year follow-up. The mean time for surgery was 41.7 ± 6.1 min. All fractures united. Radiologic analysis revealed a mean palmar tilt of 2.05° ± 0.67°, radial length in relation to the ulna was adequately restored (0.06 ± 0.05 mm difference compared to the uninjured side). As soon as 8 weeks after surgery the arc of extension/flexion reached 80% of the uninjured side. Mean Gartland-Werley Score 1 year after surgery was excellent (1.53 ± 0.41).