Treatment of distal radius fractures by intramedullar nailing with Micronail®

Objective: Distal radius fractures are common fractures in the adult population. For treatment, intramedullary nailing has the advantage of providing effective internal fixation with minimum soft tissue damage. We aimed to present our experience with the use of intramedullary nailing device Micronail® (Wright Medical Technologies, Arlington, TN, USA) in the treatment of unstable extra-articular and simple intra-articular distal radius fractures.

Methods: Forty-three patients (mean age 54.7±10.8 years; 54.7% women) with unstable extra-articular and simple intra-articular distal radius fractures suitable for closed reduction (A21, A2.2, A23, A3, C2.1)) were included in this retrospective study. Intramedullary distal radius fixation procedures were performed using Micronail® intramedullary nails in our clinic between February 2011 and January 2017. Clinical outcome measures were range of motion (ROM); visual analog scale (VAS); patient-reported Disabilities of the Arm, Shoulder and Hand [DASH] score; clinician-based Gartland–Werley score; radiographic Stewart score; radiographic parameters (radial inclination, volar tilt, radial height, radio-ulnar variance), and complications. Results: The surgery lasted an average of 32.5±2.42 min. The mean postoperative follow-up duration was 31.4±5.8 weeks. Complete fracture union was obtained at 5.24±0.7 weeks. The postoperative VAS pain score was 2.4±1.2, which was remarkably low. The DASH score was 20±3.7, the Gartland–Werley score was 5.2±4.53, and the Stewart score was 1.7±1.4 on postoperative evaluation. ROM values were over 70° for all motions. Compared with the healthy side, the median loss in ROM was less than 17° for flexion, extension, pronation, and supination. In the postoperative radiological evaluations, there were significant increases in radial inclination (p=0.005), volar tilt (p<0.001), and radial height (p<0.001), and a decrease in radio-ulnar variance (p=0.001) compared to the preoperative values. Thirty patients (69.8%) had no postoperative complications, remaining 13 patients experienced minor complications that were treated effectively. Conclusion: Intramedullar nailing with Micronail® is a minimally invasive technique, which provides effective and safe fixation of unstable extra-articular and simple intra-articular distal radius fractures.