Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant

Overview

Journal J Wrist Surg

Date 2018 Oct 24

PMID 30349747

Authors

Schneider K Rancy

Stephanie D Malliaris

Eric A Bogner

Scott W Wolfe

Affiliations

Soon will be listed here.

Abstract

CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3-20), VAS pain scores averaged 0.6 (range, 0-8) and PRWE averaged 12.1 (range, 0-53.5). Grip strength of the operated hand averaged 58 lbs (range, 20-130). ROM included: wrist flexion 73° (50-95), wrist extension 78° (60-110), pronation 77° (60-90), supination 79° (60-90), ulnar deviation 31° (5-45), and radial deviation 17° (10-30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. This is a level IV, therapeutic study.

References

Johnson N, Cutler L, Dias J, Ullah A, Wildin C, Bhowal B . Complications after volar locking plate fixation of distal radius fractures. Injury. 2013; 45(3):528-33. DOI: 10.1016/j.injury.2013.10.003. View

Safi A, Hart R, Teknedzjan B, Kozak T . Treatment of extra-articular and simple articular distal radial fractures with intramedullary nail versus volar locking plate. J Hand Surg Eur Vol. 2013; 38(7):774-9. DOI: 10.1177/1753193413478715. View

Strassmair M, Jonas M, Schafer W, Palmer A . Distal Radial Fracture Management With an Intramedullary Cage and Fragment Fixation. J Hand Surg Am. 2016; 41(8):833-40. DOI: 10.1016/j.jhsa.2016.05.008. View

Sato O, Aoki M, Kawaguchi S, Ishii S, Kondo M . Antegrade intramedullary K-wire fixation for distal radial fractures. J Hand Surg Am. 2002; 27(4):707-13. DOI: 10.1053/jhsu.2002.34371. View

Henry M . Distal radius fractures: current concepts. J Hand Surg Am. 2008; 33(7):1215-27. DOI: 10.1016/j.jhsa.2008.07.013. View

van Kampen R, Thoreson A, Knutson N, Hale J, Moran S . Comparison of a new intramedullary scaffold to volar plating for treatment of distal radius fractures. J Orthop Trauma. 2012; 27(9):535-41. DOI: 10.1097/BOT.0b013e3182793df7. View

Sammer D, Fuller D, Kim H, Chung K . A comparative study of fragment-specific versus volar plate fixation of distal radius fractures. Plast Reconstr Surg. 2008; 122(5):1441-1450. PMC: 4412272. DOI: 10.1097/PRS.0b013e3181891677. View

Kitay A, Swanstrom M, Schreiber J, Carlson M, Nguyen J, Weiland A . Volar plate position and flexor tendon rupture following distal radius fracture fixation. J Hand Surg Am. 2013; 38(6):1091-6. DOI: 10.1016/j.jhsa.2013.03.011. View

Ilyas A . Intramedullary fixation of distal radius fractures. J Hand Surg Am. 2009; 34(2):341-6. DOI: 10.1016/j.jhsa.2008.11.019. View

10.

Vlcek M, Jaganjac E, Pech J, Jonas D, Kebrle R . Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures?. Bosn J Basic Med Sci. 2014; 14(2):81-8. PMC: 4333954. DOI: 10.17305/bjbms.2014.2268. View

11.

Gradl G, Mielsch N, Wendt M, Falk S, Mittlmeier T, Gierer P . Intramedullary nail versus volar plate fixation of extra-articular distal radius fractures. Two year results of a prospective randomized trial. Injury. 2013; 45 Suppl 1:S3-8. DOI: 10.1016/j.injury.2013.10.045. View

12.

Drobetz H, Koval L, Weninger P, Luscombe R, Jeffries P, Ehrendorfer S . Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial. World J Orthop. 2016; 7(10):687-694. PMC: 5065676. DOI: 10.5312/wjo.v7.i10.687. View

13.

Hardman J, Al-Hadithy N, Hester T, Anakwe R . Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures. Int Orthop. 2015; 39(12):2381-7. DOI: 10.1007/s00264-015-2763-1. View

14.

Taras J, Zambito K, Abzug J . T-Pin for distal radius fracture. Tech Hand Up Extrem Surg. 2006; 10(1):2-7. DOI: 10.1097/00130911-200603000-00002. View

15.

Limthongthang R, Bachoura A, Jacoby S, Osterman A . Distal radius volar locking plate design and associated vulnerability of the flexor pollicis longus. J Hand Surg Am. 2014; 39(5):852-60. DOI: 10.1016/j.jhsa.2014.01.038. View

16.

Kumar S, Khan A, Sonanis S . Radiographic and functional evaluation of low profile dorsal versus volar plating for distal radius fractures. J Orthop. 2016; 13(4):376-82. PMC: 4957577. DOI: 10.1016/j.jor.2016.06.017. View

17.

Landgren M, Abramo A, Geijer M, Kopylov P, Tagil M . Fragment-Specific Fixation Versus Volar Locking Plates in Primarily Nonreducible or Secondarily Redisplaced Distal Radius Fractures: A Randomized Controlled Study. J Hand Surg Am. 2017; 42(3):156-165.e1. DOI: 10.1016/j.jhsa.2016.12.001. View

18.

Dy C, Jang E, Taylor S, Meyers K, Wolfe S . The impact of coronal alignment on distal radioulnar joint stability following distal radius fracture. J Hand Surg Am. 2014; 39(7):1264-72. DOI: 10.1016/j.jhsa.2014.03.041. View

19.

Lerch S, Sextro H, Wilken F, Wittenberg C . [Clinical and radiological results after distal radius fracture: intramedullary locking nail versus volar locking plate osteosynthesis]. Z Orthop Unfall. 2009; 147(5):547-52. DOI: 10.1055/s-0029-1185582. View

20.

Esenwein P, Sonderegger J, Gruenert J, Ellenrieder B, Tawfik J, Jakubietz M . Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg. 2013; 133(8):1155-62. DOI: 10.1007/s00402-013-1766-x. View