Masao Nishiwaki1, Kenichi Tazaki1, Asif M Ilyas2. 1. Department of Orthopaedic Surgery, Ogikubo Hospital, 3-1-24 Imagawa, Suginami-ku, Tokyo 167-0035, Japan. E-mail address for M. Nishiwaki: E-mail nishiwa@jd5.so-net.ne.jp. 2. The Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107.
Abstract
INTRODUCTION: This paper will describe the surgical technique for the treatment of unstable distal radial fractures with use of the MICRONAIL Intramedullary Distal Radius System (Wright Medical Technology, Arlington, Tennessee). STEP 1 CLOSED REDUCTION AND PINNING: The fracture must be adequately reduced and pinned prior to nail insertion. STEP 2 PERFORM EXPOSURE AND ENTER CANAL: Protect the branches of the superficial radial sensory nerve at all times. STEP 3 INSERT NAIL AND DISTAL LOCKING SCREWS: Insert the nail to a depth to place the most distal screw just proximal to the radiocarpal joint line; confirm fluoroscopically that the screw does not penetrate the articular surface. STEP 4 INSERT PROXIMAL INTERLOCKING SCREWS AND CLOSE: Confirm that the proximal interlocking screws are bicortical for adequate fixation but are not too long. STEP 5 POSTOPERATIVE MANAGEMENT: Use of a splint is followed by active and then passive range-of-motion exercises. RESULTS: We reported a prospective analysis of patients treated for an unstable distal radial fracture with an intramedullary nail. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: This paper will describe the surgical technique for the treatment of unstable distal radial fractures with use of the MICRONAIL Intramedullary Distal Radius System (Wright Medical Technology, Arlington, Tennessee). STEP 1 CLOSED REDUCTION AND PINNING: The fracture must be adequately reduced and pinned prior to nail insertion. STEP 2 PERFORM EXPOSURE AND ENTER CANAL: Protect the branches of the superficial radial sensory nerve at all times. STEP 3 INSERT NAIL AND DISTAL LOCKING SCREWS: Insert the nail to a depth to place the most distal screw just proximal to the radiocarpal joint line; confirm fluoroscopically that the screw does not penetrate the articular surface. STEP 4 INSERT PROXIMAL INTERLOCKING SCREWS AND CLOSE: Confirm that the proximal interlocking screws are bicortical for adequate fixation but are not too long. STEP 5 POSTOPERATIVE MANAGEMENT: Use of a splint is followed by active and then passive range-of-motion exercises. RESULTS: We reported a prospective analysis of patients treated for an unstable distal radial fracture with an intramedullary nail. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
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