Ilyas Asif M, Thoder Joseph J
Department of Orthopaedic Surgery & Sports Medicine, Temple Hand Center, Temple University Hospital, Philadelphia, PA 19140, USA.
J Hand Surg Am. 2008 Dec;33(10):1706-15. doi: 10.1016/j.jhsa.2008.07.004.
This study presents the preliminary experience of using an intramedullary nail for fixation of primarily extra-articular fractures and "simple" intra-articular fractures of the distal radius in 10 patients. This article will review the surgical technique, indications, and complications.
Ten patients (average age 55) with AO Type A and C distal radius fractures had fixation of the fracture with an intramedullary nail (Micronail, Wright Medical Technologies, Arlington, TN) with an average follow-up of 21 months (12-28 months).
At final follow-up, the average volar tilt was dorsal angulation of 2.2 degrees (range, +10 degrees to -20 degrees ), radial inclination was 24.1 degrees (range, 20-34 degrees ), radial height was 12.1 mm (range, 11-14 mm), and ulnar variance was -0.6 mm (range, +2 to -2 mm). All cases maintained reduction of the fracture between immediate postoperative and final radiographs, except for 2 cases that had a loss of volar tilt by greater than 5 degrees , both in AO Type A3 fractures. Range of motion included wrist flexion of 67 degrees (range, 45-90 degrees ), wrist extension of 71 degrees (range, 45-80 degrees ), supination of 82 degrees (range, 70-90 degrees ), pronation of 85 degrees (range, 75-90 degrees ), radial deviation of 23 degrees (range, 10-30 degrees ), and ulnar deviation of 38 degrees (range, 15-45 degrees ). Grip strength of the injured limb relative to the uninjured limb was 91%. According to the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the results were 8 excellent, 1 good, and 1 poor. The average DASH score was 8.1 (range, 0-57). There were 2 cases of transient superficial radial sensory neuritis and 3 cases of screw penetration into the distal radioulnar joint (DRUJ), 1 leading to symptomatic late DRUJ arthritis. There were no cases of infection, tendon injury, hardware failure or removal.
Our preliminary report finds that using the intramedullary nail in the treatment of displaced distal radius fractures can result in good functional outcome, but a high incidence of complications. We did not experience any long-term soft tissue problems. The indication for using the intramedullary nail should continue to be limited to extra-articular and simple intra-articular distal radius fractures until additional data can be obtained.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究介绍了使用髓内钉固定10例主要为关节外骨折和桡骨远端“简单”关节内骨折的初步经验。本文将回顾手术技术、适应证及并发症。
10例（平均年龄55岁）AO A型和C型桡骨远端骨折患者采用髓内钉（Micronail，Wright Medical Technologies，阿灵顿，田纳西州）固定骨折，平均随访21个月（12 - 28个月）。
末次随访时，平均掌倾角为背侧成角2.2度（范围为+10度至 - 20度），桡偏角为24.1度（范围为20 - 34度），桡骨高度为12.1毫米（范围为11 - 14毫米），尺骨变异为 - 0.6毫米（范围为+2至 - 2毫米）。除2例AO A3型骨折掌倾角丢失大于5度外，所有病例术后即刻与末次X线片之间骨折均维持复位。活动范围包括腕关节屈曲67度（范围为45 - 90度），腕关节伸展71度（范围为45 - 80度），旋后82度（范围为70 - 90度），旋前85度（范围为75 - 90度），桡偏23度（范围为10 - 30度），尺偏38度（范围为15 - 45度）。伤侧肢体握力相对于健侧肢体为91%。根据上肢、肩部和手部功能障碍（DASH）问卷，结果为8例优，1例良，1例差。平均DASH评分为8.1（范围为0 - 57）。有2例出现短暂性桡浅感觉神经炎，3例螺钉穿入下尺桡关节（DRUJ），1例导致症状性晚期DRUJ关节炎。无感染、肌腱损伤、内固定失败或取出病例。
我们的初步报告发现，使用髓内钉治疗移位型桡骨远端骨折可获得良好的功能结果，但并发症发生率较高。我们未遇到任何长期软组织问题。在获得更多数据之前，髓内钉的使用适应证应继续限于关节外和简单关节内桡骨远端骨折。
研究类型/证据水平：治疗性IV级。
