Asif M Ilyas1, Joseph J Thoder. 1. Department of Orthopaedic Surgery & Sports Medicine, Temple Hand Center, Temple University Hospital, Philadelphia, PA 19140, USA. asif.ilyas@temple.edu
Abstract
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.
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.
Authors: Justin Vaida; Patrick M Luchini; Julie E Glener; Michael W Kessler; Lucy A McCabe; John S Taras Journal: J Hand Surg Glob Online Date: 2021-06-27