Randomized clinical trial on percutaneous minimally invasive osteosynthesis of fractures of the distal extremity of the radius

Aita, Marcio Aurélio; Ferreira, Carlos Henrique Vieira; Ibanez, Daniel Schneider; Marquez, Rafael Saraiva; Ikeuti, Douglas Hideki; Mota, Rodrigo Toledo; Credidio, Marcos Vinicius; Fujiki, Edison Noboru

doi:10.1016/j.rboe.2014.04.003

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Original Articles • Rev. bras. ortop. 49 (03) • May-June 2014 • https://doi.org/10.1016/j.rboe.2014.04.003 copy

Randomized clinical trial on percutaneous minimally invasive osteosynthesis of fractures of the distal extremity of the radius^☆ ☆ Please cite this article as: Aita MA, Vieira Ferreira CH, Schneider Ibanez D, Saraiva Marquez R, Hideki Ikeuti D, Toledo Mota R, et al. Ensaio clínico randomizado de osteossíntese percutânea e minimamente invasiva das fraturas da extremidade distal do rádio. Rev Bras Ortop. 2014;49:218-226. , ^☆☆ ☆☆ Work performed by the Hand and Microsurgery Group, ABC School of Medicine, Santo André, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

the purpose of this study was to compare the postoperative radiological and clinical outcomes with minimally invasive percutaneous osteosynthesis using three implants: volar locking plate, intramedullary nail system and nonbridging external fixator for distal radius fractures.

METHODS:

forty-eight patients (A group, 16; B group 16; C group 16) underwent minimally invasive percutaneous osteosynthesis of reductible and unstable displaced (Type IIB by Rayhack Classification) distal radius fractures. In B group intramedullary nail system was used, in A group the patients were treated with volar locking plate and in C group the patients were treated by nonbridging external fixator from January 2011 to December 2012. The mean follow-up period was 12 months. Radiologic parameters, range of motion, grip strength, and disability of the arm, shoulder, and hand score were evaluated at each examination (3rd and 6th week, and 12th months). The visual analog scale of wrist pain and complications were assessed at the final follow-up.

RESULTS:

the groups did not differ significantly in radiological outcomes after 12 months, but the clinical results, VAS scale and dash score in group A (volar locking plate) and B (nail intramedullary) were statistically significantly better than that of C group (nonbridging external fixator). One patient underwent an osteosynthesis with nail intramedullary and another with external fixator (C group) developed persistent pain near the site of the superficial radial nerve because of the distal's screw and pins, respectively.

CONCLUSION:

in clinical parameters, significant differences in outcomes were found between groups A and B after six weeks versus C group.

Fractures of the radius; Internal fracture fixation; Bone plate

Number	Age (years)	Side affected	Follow-up (months)	Sex	Complications
I	22	Dominant	12	Male	No
II	19	No	12	Male	No
III	42	No	12	Female	No
IV	21	Dominant	12	Female	No
V	38	No	12	Male	No
VI	51	No	12	Female	No
VII	26	Dominant	12	Male	No
VIII	56	Dominant	12	Female	No
IX	55	No	12	Female	No
X	39	No	12	Female	No
XI	23	No	12	Male	No
XII	39	Dominant	12	Female	No
XIII	30	Dominant	12	Female	No
XIV	26	Dominant	12	Male	No
XV	24	No	12	Male	No
XVI	41	No	12	Female	No

Number	Age (years)	Side affected	Follow-up (months)	Sex	Complications
I	33	Dominant	12	Female	No
II	36	Dominant	12	Female	No
III	41	Dominant	12	Male	No
IV	22	Dominant	12	Male	No
V	38	No	12	Male	No
VI	26	No	12	Female	No
VII	26	Dominant	12	Male	No
VIII	51	Dominant	12	Female	No
IX	25	No	12	Female	No
X	28	No	12	Male	No
XI	23	Dominant	12	Male	No
XII	38	No	12	Female	Yes
XIII	26	No	12	Female	No
XIV	46	Dominant	12	Female	No
XV	32	Dominant	12	Male	No
XVI	38	No	12	Male	No

Number	Age (years)	Side affected	Follow-up (months)	Sex	Complications
I	34	Dominant	6	Male	No
II	45	No	6	Female	No
III	58	Dominant	6	Male	No
IV	42	Dominant	6	Female	No
V	61	Dominant	6	Female	No
VI	29	No	6	Female	No
VII	36	Dominant	6	Female	No
VIII	52	Dominant	6	Female	Yes
IX	23	No	6	Male	No
X	39	No	6	Male	No
XI	34	No	12	Male	No
XII	43	Dominant	12	Male	No
XIII	52	Dominant	12	Female	No
XIV	29	No	12	Female	No
XV	37	No	12	Male	No
XVI	40	Dominant	12	Female	No

Parameters	Group A - plate	Group B - nail	Group C - fixator
Pain (VAS)	3.8	2.6	3.75
DASH	36.4	23.6	68.13
Strength	53.6	66.67	29.03
ROM	86.1	89.72	71.0
Complications	-	6.25	6.25

Parameters	Group A - plate	Group B - nail	Group C - fixator
Pain (VAS)	1.80	1.00	1.70
DASH	14.7	10.4	29.5
Strength	78.44	88.89	60.00
ROM	94.60	98.01	83.00
Complications	-	6.25	6.25

Parameters	Group A - plate	Group B - nail	Group C - fixator
Pain (VAS)	0.0	0.0	0.0
DASH	1.1	1.2	1.50
Strength	97.00	98.90	94.50
ROM	99.95	100	99.4
Complications	-	-	-

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] ^*Corresponding author. E-mail: drdanielsi@hotmail.com(D. Schneider Ibanez).