Intramedullary nailing vs volar plating for distal radius fractures
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Intramedullary Nailing for Distal Radius Fractures: A Systematic Review RW Jordan, A Saithna Southport and Ormskirk Hospitals NHS Trust, Merseyside, UK
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Transcript of Intramedullary nailing vs volar plating for distal radius fractures
Intramedullary Nailing for
Distal Radius Fractures: A
Systematic Review
RW Jordan, A Saithna
Southport and Ormskirk Hospitals
NHS Trust, Merseyside, UK
Introduction
Distal radius fractures are common injuries
No clear consensus regarding optimal management of unstable fractures
Open reduction and internal fixation with volar plates had become increasingly popular
Recent studies suggested K-wires as effective as plate fixation
Intramedullary nails are an alternative Reduced risk of tendon injury
Reduced risk of intra-articular screw penetration
This article systematically reviews the biomechanics, outcomes and complications of intramedullary nails
Methods
Systematic review of the literature using the online databases Medline and EMBASE performed on the 1st of August 2014
All studies assessed adults who had sustained any type of distal radius fracture treated with an IM nail
Data regarding clinical outcomes and complications were extracted
These studies were appraised independently by both authors using a validated quality assessment scale
Results
16 studies were included for review
The biomechanical studies concluded that intramedullary nails had at least comparable strength to locking plates
The clinical studies reported that IM nailing was associated with comparable ROM, functional outcome and grip strength to alternative fixation techniques.
However, the mean complication rate was 17.6% (range 0 to 50%) with the most common complication being neurapraxia of the superficial radial nerve in 9.5%.
Conclusion IM nailing can give comparable clinical results to
current treatment modalities in extra-articular and simple intra-articular distal radius fractures.
However the evidence is insufficient to determine whether IM nailing has any clinically important advantage over well-established alternatives.
The complication rate reported is higher than that in contemporary studies for volar plating
Further adequately powered RCTs comparing the technique to volar plates and K-wire fixation are required
