IS INTRAMEDULLARY ANGULAR STABLE NAILING WITH THE TARGON DR® NAIL BENEFICIAL IN OSTEOPOROTIC DISTAL RADIAL FRACTURES WHEN COMPARED TO VOLAR PLATING. A PROSPECTIVE RANDOMIZED MULTICENTER TRIAL EMPLOYING OSTEODENSITOMETRY.

Abstract

Objective: Osteoporotic fractures of the distal forearm are demanding in terms of operative therapy and implants used. Volar fixed angle plating has become a standard procedure for these fractures. Recently intra-medullary nailing was introduced in clinical practice for the use in distal radial fractures. This randomized multi-center study compares both fixation techniques in terms of clinical and radiological outcome as well as quality of life score.

Material and Methods: Up to now a total of 85 patients with extra- and intraarticular unstable fractures of the distal radius were included. 53 patients (Targon DR®, B. Braun-Aesculap: n=24; 2.4 mm plate, Synthes: n=29) completed the 6 months follow-up. Follow up examinations included an osteodensitometry using pQCT, X-ray analysis and a detailed clinical function examination. In addition the SF36 questionaire for quality of life assessment was carried out.

Results: The operation time for volar plating was significantly longer than for intramedullary nailing (50.3±20.2 min versus 40.2±13.4 min), as was the time in hospital (5.4±1.8 days versus 2.2±0.6 days) (MW±SD; p< 0.05; Student-t-Test, post hoc: Bonferonni). The Gartland an Werley function score averaged 2.7±1.1 versus 1.9±0.8 for volar plating in comparision to treatment with the Targon DR® nail and thus just failed to reach statistical significance (p = 0.052). Radiological Evaluation revealed bony healing in all patients of both groups. Radial length was maintained in all but one patient (96%) in the nailing group and all but 2 patients (93%) in the plating group. A loss of volar tilt −5°was seen in 1 patient in the nailing group (4%) and 3 patients in the plating group (10%). Of interest radiological signs of bony healing developed much faster after intramedullary nailing. The Quality of life as measured by the SF36 was minimaly diminished in both groups (body/social function: Targon DR®: 56.3±25.1/63.4±21.2 points − 2.4 mm plate: 52.8±23.3/60.5±23.3 points). Osteoporotic bone loss was detected in a total of 72% of patients. Osteoporosis had no adverse effects on bony healing or functional parameters. We encountered two complications. One mild CRPS (volar plating) and in one case paraesthesia of the R. superficialis n. radialis (intramedullary nailing).

Conclusion: Both intramedullary nailing with the Targon DR® nail and volar plating using a 2.4 mm volar fixed angle plate allows stable fixation of osteoporotic distal forearm fractures. Lower operation time and minimally invasive operative procedure of intramedullary nailing is accompanied by faster mobilization.