[Clinical and Radiological Results After Distal Radius Fracture: Intramedullary Locking Nail Versus Volar Locking Plate Osteosynthesis]

Aim: Treatment of distal radius fractures with the volar locking plate provides a stable fixation and early postoperative function. However, after intramedullary osteosynthesis systems for long bones had been established an intramedullary locking nail (Targon DR, Aesculap) for treatment of distal radius fractures was developed. Thus, the aim of this study was to compare the outcomes after volar locking plate osteosynthesis (Aptus, Medartis) and intramedullary osteosynthesis (Targon DR nail) for the distal radius.

Method: Between 01/07 and 11/07 13 patients (average age: 60 [30-83] years) with distal radius fractures treated with the Targon DR nail were compared to 12 patients (average age: 57 [20-78] years) treated with a volar locking plate (Aptus, Medartis). Follow-up of the Targon DR group was 5.0 (1.9-8.9) months and 8.5 (2.1-11.6) months for the Aptus group. Parameters were: "Disabilities of the Arm, Shoulder and Hand" (DASH), Gartland-Werley and Martini scores, range of motion (ROM) and radiological parameters.

Results: The Targon DR group achieved "good" results in the Gartland-Werley score with 6.9 (0-13) points and in the Martini score with 29.9 (20-38) points. A "good" result in the Gartland-Werley score (6.5 [3-11] points) and a "satisfactory" outcome with 27.9 (19-33) points in the Martini score were recorded in the Aptus group. The DASH score showed a higher subjective satisfaction after treatment with the Targon DR nail with 14 (0-39) compared to 23 (4-73) points after treatment with volar plating. ROM in both groups was not significantly different. The Targon DR group achieved an extension/flexion of 99 degrees, an ulnar/radial duction of 50 degrees and a supination/pronation of 139 degrees. After treatment with the volar locking plate the patients showed an extension/flexion of 103 degrees, an ulnar/radial duction of 57 degrees and a supination/pronation of 145 degrees. Postoperative radiographs revealed a better palmar inclination in the Aptus group (-2.5 degrees vs. 5.5 degrees) whereas reconstruction of the radial length was more successful in the Targon DR group (0.8 vs. -0.3 mm).

Conclusion: The compared osteosynthesis systems achieved equally good functional outcomes after distal radius fractures. However, patients treated with the Targon DR nail showed a superior subjective satisfaction, probably because of the less invasive surgical approach.