Intramedullary nail versus volar plate fixation of extra-articular distal radius fractures. Two year results of a prospective randomized trial Gertraud Gradl b , Nadja Mielsch a , Martina Wendt a , Steffi Falk a , Thomas Mittlmeier a , Philip Gierer a , Georg Gradl a, * a Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany b Department of Trauma and Reconstructive Surgery, Aachen University Medical Center, Pauwelstrasse 30, 52074 Aachen, Germany Introduction There are three broad categories of treatment for distal radial fractures: closed reduction and immobilization in a cast, percuta- neous fixation with Kirschner wires and/or external fixation, and open reduction and internal fixation. While each has merits and disadvantages, there is no consensus regarding which is the best treatment option [1]. A literature review by the Cochrane Collaboration revealed a lack of robust clinical evidence to support any one intervention over another [2]. Recently, intramedullary techniques have been introduced for stabilization of displaced distal radius fractures [3–5]. The purported benefits include limited soft tissue dissection, a low profile implant with less risk of soft tissue irritation, divergent subchondral screw placement, and locked fixed-angle fixation, affording sufficient stability to allow early wrist motion [3–5]. However, the role of intramedullary stabilization of distal radius fractures remains unclear. We hypothesized that there is no significant difference in functional and radiological outcome of unstable dorsally displaced extra-articular fractures of the distal radius treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation (Targon DR). Materials and methods Study design This was a single-centre prospective randomized trial. Injury, Int. J. Care Injured 45S (2014) S3–S8 A R T I C L E I N F O Keywords: Distal radius fractures Locked plating Intramedullary nailing Complications Functional outcome A B S T R A C T Background: Intramedullary techniques for stabilization of displaced distal radius fractures are now available. Purported benefits include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial is 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 unstable dorsally displaced extra-articular fractures of the distal radius. Methods: We conducted a single-centre, parallel-group trial, with unrestricted randomization. Patients with dorsally displaced extra-articular distal radius fractures were randomized to receive volar locking plate (n = 72) fixation or intramedullary nailing (n = 80). 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, 6 months, 1 year 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 during the entire follow-up period (p > 0.05). There was no significant difference between treatment groups with respect to volar tilt or ulnar variance (p > 0.05). There was no significant difference in the complication rate between groups (p > 0.05). Conclusions: The present study supports the view that intramedullary nail fixation and volar plate fixation for the treatment of displaced extra-articular distal radius fractures have equivalent radiographic and functional outcomes. Level of evidence: Level I therapeutic study. ß 2013 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +49 381 4946262; fax: +49 381 4946052. E-mail address: georg.gradl@med.uni-rostock.de (G. Gradl). Contents lists available at ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y 0020–1383/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.injury.2013.10.045