Randomized clinical trial on percutaneous minimally invasive osteosynthesis of fractures of the distal extremity of the radius

Abstract

Objectivesthe purpose of this study was to compare the postoperative radiological and clinical outcomes with minimally invasive percutaneous osteosynthesis using three implants: volar locking plate, intramedullary nail system and nonbridging external fixator for distal radius fractures.Methodsforty-eight patients (A group, 16; B group 16; C group 16) underwent minimally invasive percutaneous osteosynthesis of reductible and unstable displaced (Type IIB by Rayhack Classification) distal radius fractures. In B group intramedullary nail system was used, in A group the patients were treated with volar locking plate and in C group the patients were treated by nonbridging external fixator from January 2011 to December 2012. The mean follow-up period was 12 months. Radiologic parameters, range of motion, grip strength, and disability of the arm, shoulder, and hand score were evaluated at each examination (3rd and 6th week, and 12th months). The visual analog scale of wrist pain and complications were assessed at the final follow-up.Resultsthe groups did not differ significantly in radiological outcomes after 12 months, but the clinical results, VAS scale and dash score in group A (volar locking plate) and B (nail intramedullary) were statistically significantly better than that of C group (nonbridging external fixator). One patient underwent an osteosynthesis with nail intramedullary and another with external fixator (C group) developed persistent pain near the site of the superficial radial nerve because of the distal's screw and pins, respectively.Conclusionin clinical parameters, significant differences in outcomes were found between groups A and B after six weeks versus C group.

Percutaneous pinning versus volar locking plate internal fixation for unstable distal radius fractures: a meta-analysis

“…The full texts of the remaining 34 articles were reviewed, and 14 were excluded, the reasons for which are shown in Figure 1. Thus, 20 articles were included in the meta-analysis (Aita et al., 2014; Bahari-Kashani et al., 2013; Costa et al., 2014; Dzaja et al., 2013; Egol et al., 2008; Goehre et al., 2014; Gradl et al., 2013; Grewal et al., 2011; Hollevoet et al., 2011; Jeudy et al., 2012; Karantana et al., 2013; Kumbaraci et al., 2014; Lee et al., 2012; Loisel et al., 2015; Maire et al., 2013; Marcheix et al., 2010; McFadyen et al., 2011; Rozental et al., 2009; Tronci et al., 2013; Williksen et al., 2013).

Figure 1.Flow diagram of study selection.

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Análise clínica e radiológica do resultado placa ponte versus fixador externo na fratura cominutiva do rádio distal

“…This finding is in line with the observation by Schønnemann et al 27 that internal synthesis materials have better outcomes when external fixation is compared with intramedullary fixation. Aita et al 28 compared the distal radial fixation with plates, nails and external fixators, and they observed that, at the third postoperative week, the grip strength was lower in the subjects treated with external fixators compared to other techniques; however, after one year, the grip strength was similar in the patients from the three groups.…”

“…This outcome may be attributed to the reduction in fractures with similar radiographic features, because a better reduction of the fracture results in improved range of motion and less pain. 30 Aita et al 28 compared locked volar plates, intramedullary nails and external fixators for the treatment of distal radius fractures, and they found a lower rate of pain in patients with internal synthesis material compared to those receiving external fixators after the third week.…”

“…Este achado vai de encontro com o obtido por Schønnemann et al, 27 que observaram resultados melhores nos pacientes com material de síntese interno em comparação à fixação externa com a intramedular. Aita et al 28 compararam a fixação de rádio distal com placa, haste e fixador externo, e observaram que, na terceira semana pós-operatória, a força de preensão com o fixador externo era menor do que nas demais técnicas, mas, após um ano, a força de preensão era similar entre as três técnicas.…”

“…Poderíamos atribuir isso à redução das fraturas com dados radiográficos semelhantes, pois, com uma melhor redução da fratura, a amplitude de movimento é melhor e com menos dor. 30 Aita et al 28 compararam as técnicas de placa volar bloqueada, haste intramedular e fixador externo em fraturas distais do rádio, e constataram menor taxa de dor em pacientes com material de síntese interno do que em fixadores externos após a terceira semana.…”