Falk Steffi S I, Mittlmeier Thomas, Gradl Georg
Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany.
Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany.
Injury. 2016 Dec;47 Suppl 7:S31-S35. doi: 10.1016/S0020-1383(16)30851-8.
Distal radius fracture are common injuries but no gold standard for their therapy exists. The aim of this study was to evaluate the quality of fracture care in distal radius fractures using an intramedullary implant (Targon DR interlocking nail). The nail had been developed to minimize the surgical exposure, increase fixation strength, to prevent tendon irritations and to allow for a fast return to activity.
Prospective study reports the result of 43 patients with an age over 70 years (range 70-91 years) treated by closed reduction and intramedullary fixation. Inclusion criteria were displaced unilateral isolated AO A or C type fractures. The Targon DR interlocking nail was used for all patients. The minimum follow up was 12 months.
All fractures united within 2 months. At one-year follow-up the patients had a mean extension of 96.1 ± 1.5%, flexion of 91.6 ± 3.3%, pronation of 99.4 ± 0.7%, supination of 94.0 ± 2.0%, radial abduction of 98.1 ± 1.3%, ulnar deviation of 91.4 ± 3.0% and a grip strength of 91.5 ± 4.3% compared to the contralateral wrist. Pain score measured by a Visual Analogue Scale scored 0.0 ± 0.0 at rest and in activity 0.3 ± 0.3. The mean Castaing Score was good (1.06 ± 0.30) and the Gartland & Werley Score was excellent (1.50 ± 0.57). The mean radial shortening was 0.2 ± 0.1 mm and radial inclination was 3.1 ± 1.1° (range +15° to 0°). No deep soft-tissue or chronic osseous infections were observed. One patient developed a carpal tunnel syndrome. Paraesthesia or dysaesthesia of the superficial radial nerve was registered in seven patients and fully recovered in four patients. There were two cases of single screw loosening. We also found two cases of screw overlength and consecutive contact with the ulnar head, one patient underwent implant removal. Another patient developed CRPS (2.3%). We did not observe any case of hardware failure, tendon irritation or tendon rupture.
In geriatric patients intramedullary interlocking nailing of displaced extraarticular or intraarticular distal radius fracture with the Targon DR nail represents a viable treatment option and alternative to the use of volar interlocking plating in terms of fracture reduction, maintenance of reduction and functional outcome.
桡骨远端骨折是常见损伤，但目前尚无治疗的金标准。本研究旨在评估使用髓内植入物（Targon DR交锁髓内钉）治疗桡骨远端骨折的护理质量。该髓内钉的设计目的是尽量减少手术暴露、增强固定强度、防止肌腱刺激并能使患者快速恢复活动。
前瞻性研究报告了43例年龄超过70岁（年龄范围70 - 91岁）患者的治疗结果，这些患者均接受了闭合复位和髓内固定治疗。纳入标准为移位的单侧孤立AO A型或C型骨折。所有患者均使用Targon DR交锁髓内钉。最小随访时间为12个月。
所有骨折均在2个月内愈合。在1年随访时，与对侧腕关节相比，患者的平均伸展度为96.1 ± 1.5%，屈曲度为91.6 ± 3.3%，旋前度为99.4 ± 0.7%，旋后度为94.0 ± 2.0%，桡侧外展度为98.1 ± 1.3%，尺偏度为91.4 ± 3.0%，握力为91.5 ± 4.3%。采用视觉模拟量表测量的疼痛评分在休息时为0.0 ± 0.0，活动时为0.3 ± 0.3。平均Castaing评分为良好（1.06 ± 0.30），Gartland & Werley评分为优秀（1.50 ± 0.57）。平均桡骨短缩为0.2 ± 0.1 mm，桡骨倾斜度为3.1 ± 1.1°（范围为 +15°至0°）。未观察到深部软组织或慢性骨感染。1例患者出现腕管综合征。7例患者出现桡浅神经感觉异常或感觉障碍，其中4例完全恢复。有2例出现单枚螺钉松动。我们还发现2例螺钉过长并与尺骨头连续接触病例，1例患者接受了植入物取出术。另1例患者发生了复杂性区域疼痛综合征（CRPS，2.3%）。未观察到任何植入物失效、肌腱刺激或肌腱断裂的病例。
对于老年患者，使用Targon DR髓内钉对移位的关节外或关节内桡骨远端骨折进行髓内交锁钉固定，在骨折复位、维持复位及功能结果方面，是一种可行的治疗选择，可替代掌侧交锁钢板固定。
