[Fixation of distal radial fractures with the Targon DR nail]

Abstract

Objective: Anatomic restoration and intramedullary fixation of distal radial fractures using a hybrid between plate and nail (Targon DR). The technique provides a less invasive operative approach from radial.

Indications: Extraarticular fractures of the distal radius with dorsal comminution. Intraarticular fractures without displacement and with a sagittal fracture line.

Contraindications: Flexion fractures, intraarticular fractures with displacement of the articular surface or a frontal fracture line.

Surgical technique: 4-cm skin incision from the tip of the radial styloid. Careful dissection of the superficial branch of the radial nerve. Preparation of the bone between first and second extensor compartment. Reduction of the fracture, insertion of a Kirschner wire from the tip of the styloid across the fracture line. Opening of the intramedullary canal with a cannulated drill using the Kirschner wire as a guide. Stepwise widening of the intramedullary canal with profilers. Implantation of the Targon DR device. Interlocking using an aiming jig. Replacement of Kirschner wires by screws, removal of the aiming jig, and wound closure.

Postoperative management: Palmar splint for 2-14 days. Immediate functional after treatment. Full weight bearing 6 weeks after surgery.

Results: From December 2006 to May 2008, 103 patients were treated with a Targon DR nail. 95 patients experienced the 8-week follow-up, 50 patients the 1-year follow-up. The mean time for surgery was 41.7 +/- 6.1 min. All fractures united. Radiologic analysis revealed a mean palmar tilt of 2.05 degrees +/- 0.67 degrees , radial length in relation to the ulna was adequately restored (0.06 +/- 0.05 mm difference compared to the uninjured side). As soon as 8 weeks after surgery the arc of extension/flexion reached 80% of the uninjured side. Mean Gartland-Werley Score 1 year after surgery was excellent (1.53 +/- 0.41).