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J Wrist Surg 2015; 04(04): 292-300
DOI: 10.1055/s-0035-1565926
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Volar, Intramedullary, and Percutaneous Fixation of Distal Radius Fractures

Ram Alluri
1   Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
,
Matthew Longacre
1   Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
,
William Pannell
1   Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
,
Milan Stevanovic
1   Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
,
Alidad Ghiassi
1   Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
› Author Affiliations
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Publication History

Publication Date:
29 October 2015 (online)

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Abstract

Background The management of extra-articular distal radius fractures is highly variable, with no clear consensus regarding their optimal management.

Purpose To assess comparatively the biomechanical stability of Kirschner wire (K-wire) fixation, volar plating, and intramedullary nailing for unstable, extra-articular distal radius fractures with both (1) constant and (2) cyclical axial compression, simulating forces experienced during early postoperative rehabilitation.

Methods Twenty-six volar locking plate, intramedullary nail, and K-wire bone-implant constructs were biomechanically assessed using an unstable extra-articular distal radius bone model. Bone implant models were created for each type of construct. Three samples from each construct underwent compressive axial loading until fixation failure. The remaining samples from each construct underwent fatigue testing with a 50-N force for 2,000 cycles followed by repeat compressive axial loading until fixation failure.

Results Axial loading revealed the volar plate was significantly stiffer than the intramedullary nail and K-wire constructs. Both the volar plate and intramedullary nail required greater than 300 N of force for fixation failure, while the K-wire construct failed at less than 150 N. Both the volar plate and intramedullary nail demonstrated less than 1 mm of displacement during cyclic loading, while the K-wire construct displaced greater than 3 mm. Postfatigue testing demonstrated the volar plate was stiffer than the intramedullary nail and K-wire constructs, and both the volar plate and intramedullary nail required greater than 300 N of force for fixation failure while the K-wire construct failed at less than 150 N.

Conclusions Volar plating of unstable extra-articular distal radius fractures is biomechanically stiffer than K-wire and intramedullary fixation. Both the volar plate and intramedullary nail demonstrated the necessary stability and stiffness to maintain anatomic reduction during the postoperative rehabilitation period.

Clinical Relevance Both the volar plate and intramedullary nail demonstrated the necessary biomechanical stability to maintain postoperative reduction in extra-articular distal radius fractures, warranting further clinical comparison.

Keywords

biomechanics - distal radius - fracture - intramedullary