Gradl Gertraud, Falk Steffi, Mittlmeier Thomas, Wendt Martina, Mielsch Nadja, Gradl Georg
Department of Trauma and Reconstructive Surgery, Aachen University Medical Center, Pauwelstrasse 30, 52074 Aachen, Germany.
Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany.
Injury. 2016 Dec;47 Suppl 7:S25-S30. doi: 10.1016/S0020-1383(16)30850-6.
Proposed benefits of intramedullary techniques include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial was that there is no significant difference with respect to functional outcome, pain and disability between patients treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation of intra-articular fractures of the distal radius.
We conducted a single-centre, prospective randomized matched-pairs trial. Patients with intraarticular distal radius fractures with metaphyseal comminution and a sagittal fracture line (AO 23 C2.1) were randomized to receive volar locking plate fixation (n = 14) or intramedullary nailing (n = 14). The outcome was measured on the basis of the Gartland and Werley and Castaing score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including volar tilt and ulnar variance. Clinical and radiographic assessment was performed at 8 weeks and 2 years after the operation.
There were no significant differences between groups in terms of range of motion, grip strength or the level of pain at eight weeks. At the final follow up, patients in the nail group had regained more extension than in the plate group (98% of the unaffected side vs. 94%, this however, did not reach significance). Reduction was maintained in both groups; however volar tilt and ulnar variance were significantly better in the plate group. There was no significant difference in the complication rate between groups.
The present study suggests that intramedullary nail fixation is a reasonable alternative to volar plate fixation for the treatment of intra-articular distal radius fractures and both techniques can yield reliably good results.
髓内技术的潜在益处包括软组织剥离有限，同时提供足够的稳定性以允许早期腕关节活动。这项随机试验的主要无效假设是，对于桡骨远端关节内骨折，采用2.4毫米掌侧锁定钢板固定或髓内钉固定治疗的患者在功能结果、疼痛和残疾方面没有显著差异。
我们进行了一项单中心、前瞻性随机配对试验。将伴有干骺端粉碎和矢状骨折线（AO 23 C2.1）的桡骨远端关节内骨折患者随机分为接受掌侧锁定钢板固定组（n = 14）或髓内钉固定组（n = 14）。根据Gartland和Werley以及Castaing评分、疼痛程度、腕关节活动范围、并发症发生率以及包括掌倾角和尺骨变异在内的影像学测量结果来评估预后。在术后8周和2年进行临床和影像学评估。
两组在8周时的活动范围、握力或疼痛程度方面没有显著差异。在最终随访时，髓内钉组患者的伸展恢复程度高于钢板组（健侧的98%对94%，然而，这未达到显著差异）。两组均维持了复位；然而，钢板组的掌倾角和尺骨变异明显更好。两组之间的并发症发生率没有显著差异。
本研究表明，髓内钉固定是治疗桡骨远端关节内骨折的一种合理替代掌侧钢板固定的方法，两种技术都能可靠地产生良好效果。
