title: Fixation of intra-articular fractures of the distal radius using intramedullary nailing: a randomized trial versus palmar locking plates.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Trauma and Reconstructive Surgery, Aachen University Medical Center, Pauwelstrasse 30, 52074 Aachen, Germany.
authors.forename: Gertraud
authors.initials: G
authors.lastname: Gradl
authors.affiliation: Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany.
authors.forename: Steffi
authors.initials: S
authors.lastname: Falk
authors.affiliation: Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mittlmeier
authors.affiliation: Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Wendt
authors.affiliation: Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany.
authors.forename: Nadja
authors.initials: N
authors.lastname: Mielsch
authors.affiliation: Clinic for Trauma Surgery, Orthopedic Surgery and Reconstructive Surgery, Munich Municipal Hospital Group, Sanatoriumsplatz 2, 81545 München, Germany. Electronic address: Georg.Gradl@klinikum-muenchen.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Gradl
mesh_terms: D005260:Female; D005471:Fluoroscopy; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D005858:Germany; D018737:Hand Strength; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053401:Palmar Plate; D011446:Prospective Studies; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology*
keywords: intraarticular distal radius fracture; intramedullary technique; prospective randomized trial