Distal Radial Fracture Management With an Intramedullary Cage and Fragment Fixation.
OBJECTIVE
To examine the outcomes associated with the treatment of distal radial fractures with an expandable intramedullary cage and fragment-specific screw fixation.


METHODS
A prospective multicenter case series of 100 patients with a fracture of the distal radius treated with the "Cage System" was undertaken. Primary patient outcomes included Disabilities of the Arm, Shoulder, and Hand, Patient-Related Wrist/Hand Evaluation questionnaires, and adverse events associated with the device. Secondary outcomes included wrist range of motion and radiographic findings.


RESULTS
Follow-up was performed at intervals of 2 weeks, 4 to 6 weeks, 12 weeks, and 1 year. Ninety-one patients were available for follow-up at 2 weeks, 87 at 4 to 6 weeks, 73 at 3 months, and 61 at 12 months. The mean Disabilities of the Arm, Shoulder, and Hand score at 3 months was 21; at 12 months, it was 9. The mean total Patient-Reported Wrist/Hand Evaluation score at 3 months was 21; at 12 months, it was 11. There were 5 adverse events (5%)-2 involving radial nerve irritation and 3 involving tendon irritation from screws. Four of these 5 patients underwent surgical intervention, a neurolysis in 1 patient and removal of screws in 3. All patients were free of adverse-event symptoms at 3 months' follow-up. Wrist range of motion improved most rapidly in the first 12 weeks following surgery and continued to improve throughout follow-up. The fracture reduction achieved at surgery was maintained throughout the healing process. There was evidence of callus formation at the fracture as early as 2 weeks after surgery with 100% of fractures healed at 3 months.


CONCLUSIONS
An expandable intramedullary cage with fragment-specific screw fixation provides maintenance of fracture reduction with a low complication rate.


METHODS
Therapeutic IV.
Klinikum Starnberg, Starnberg, Germany.
Michael K
MK
Strassmair
St. Josef Krankenhaus, Moers, Germany.
Michael
M
Jonas
Kreiskrankenhaus Gummersbach, Gummersbach, Germany.
Walter
W
Schäfer
SUNY Upstate Medical University, Institute for Human Performance, Syracuse, NY. Electronic address: palmerak46@gmail.com.
Andrew
A
Palmer
D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005858:Germany; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*
Distal radial fracture; cage fixation; intramedullary fracture fixation