Fixation of unstable distal radius fractures by using expandable Intramedullary nailing system in adult patients

Abstract

Objective: To present our experience on intramedullary nailing device Sonoma Wrx (Sonoma Orthopedic Products Inc., Santa Rosa, CA, USA) used for internal fixation of extra-articular or simple intra-articular distal radius fractures in adult population.

Methods: This study was conducted from February 2011 to October 2016. A total of 48 patients (mean age 47.3±5.6 years, 35.4% females) with distal radius fracture, who underwent intramedullary distal radius fixation by using Sonoma Wrx were included in this retrospective study. Clinical outcome measures (range of motion [ROM], visual analog scale [VAS]), functional outcomes (Disabilities of the Arm, Shoulder and Hand [DASH] score and Gartland-Werley score), radiographic scores (Stewart score) and parameters (radial inclination, volar tilt, radial height, radio-ulnar variance) and complications were evaluated.

Results: The total surgery time was 24.3±2.3 minutes. Patients were followed up for 24.7±3.4 weeks. Complete fracture union was obtained at 5.5±0.9 weeks. The postoperative low VAS pain score (1.6±0.93) and high ROM values (76.7° for extension, 78.5° for supination, 80.1° for flexion, and 82.3° for pronation) indicated a very good clinical outcome. DASH score of 8.3±1.5 and Gartland-Werley score of 2.8±4.1 showed good functional outcome. The radiographic Stewart score was 1.0±1.2. Radial inclination, volar tilt, and radial height significantly increased (p<0.001), and radio-ulnar variance decreased (p=0.001) with surgery. No postoperative complication was recorded in 40 patients (83.3%).

Conclusions: Sonoma Wrx, which is an expansible intramedullary elastic locking distal radius nail, offers a good alternative technique for internal fixation of unstable distal radius fractures with the advantage of minimum soft-tissue dissection and related postoperative complications.

Keywords: Distal radius fracture; Internal fixation; Intramedullary nailing.

Fig. 1

Anteroposterior and lateral radiographics of distal radius fractures before (a) and after (b) internal fixation with intramedullary nailing device Sonoma Wrx.

Fig. 2

The box-and-whisker plots showing the loss in ROM degrees compared to healthy side for flexion, extension, pronation, and supination. The horizontal line within the box indicates the median, boundaries of the box indicate the 25th and 75th percentile, and the whiskers indicate the highest and lowest values of the results. The mild outliers are marked with dots.