Randomised study of non-bridging external fixation compared with intramedullary fixation of unstable distal radial fractures

Abstract

This is a randomised study to compare two types of osteosynthesis to mobilise wrists after distal fractures of the radius. Inclusion criteria were Older type 2 and 3 fractures. External fixation was managed with Hoffmann II compact non-bridging. Internal fixation was managed with Micronail. Patients were followed up for 12 weeks. The primary outcome was the results of the disabilities of arm, shoulder and hand (DASH) questionnaire. The secondary outcomes were answers to the patient-rated wrist evaluation (PRWE), grip strength, satisfaction, radial length, and volar tilt. Thirty patients were randomised to have external fixation and 31 to have internal fixation.There were no significant differences in DASH score. Internal fixation gave significantly better grip strength at five (p = 0.00) and 12 weeks (p = 0.03). The operating time was significantly shorter (p = 0.00) when non-bridging external fixation was used, and there were minor radiological differences. An activity-based costing analysis showed that external fixation cost three times more overall.

Good radiological and functional results after intramedullary nailing of distal radius fractures

“…However, we also found that we were not able to restore an anatomical volar tilt of the joint surface, just as in the study by Schønnemann et al [14] in 2011, who found that radial length may be restored using Micronail Ò , but restoration of volar tilt beyond neutral position was not possible. In contrast, Nishiwaki et al [13] achieved anatomically correct healing of the fractures in 93% of their patients using Micronail Ò for internal fixation.…”

“…Nishiwaki et al [13] had only transistent sensory problems and no persistent nerve damage. Schønnemann et al [14] had only one of 30 patients with persistent nerve damage, indicating that the insertion of the Micronail Ò may be done with a low complication rate, and the relatively high number of patients with persistent sensory problems in our study may reflect a learning curve in the department and that the operations were performed by only one specialist and by numerous surgeons in training. Another advantage of intramedullary nailing is that the fixation material is hidden inside the bone and this may prevent the need of implant removal.…”

“…Its theoretical advantages are good stability of the fracture combined with a minimally invasive approach that diminishes scarring and soft tissue damage, irritation of the tendon, and allows early movement [10][11][12]. Only a few studies have evaluated the results after Micronail Ò internal fixation of distal radius fractures [13][14][15][16] and the aim of this study was to evaluate the results after fixation of distal radius fractures using Micronail Ò internal fixation with special focus on long-term complications and the need for reoperation to remove the implant.…”

Resultados do tratamento cirúrgico das fraturas do rádio distal: estudo clínico com técnica de osteossíntese percutânea e minimamente invasiva

“…Os dados obtidos neste estudo também foram comparados com os trabalhos publicados na literatura [11][12][13][14][15] . Obtivemos resultados Tratamento cirúrgico das fraturas do rádio distal semelhantes àqueles da pesquisa de Schonemann et al…”

“…Os pacientes foram submetidos à osteossíntese minimamente invasiva e percutânea, utilizando-se haste intramedular bloqueada 5,11 (Figura 2), conforme descrito a seguir: 1. Realiza-se redução incruenta da fratura e estabiliza-se provisoriamente com um ou dois fios de Kirschner inseridos na região da ulna distal até a coluna medial do rádio, com o auxílio da radioscopia.…”