Intramedullary fixation of displaced distal radius fractures: a preliminary report.

PURPOSE

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.

METHODS

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).

RESULTS

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.

CONCLUSIONS

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.