Distal Radius Fractures Managed by Osteosynthesis Using Intramedullary Nails – Initial Information

Česká verzia

Authors: Martin Vlček ; P. Višňa
Authors place of work: 1. ortopedická klinika FN Motol, Praha, přednosta prof. MUDr. A. Sosna, DrSc.
Published in the journal: Rozhl. Chir., 2008, roč. 87, č. 12, s. 628-635.
Category: Monothematic special - Original

Summary

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

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