title: Prospective study of distal radial fractures treated with an intramedullary nail.
abstract: BACKGROUND
  Intramedullary nailing for the treatment of unstable distal radial fractures is reported to provide stable fixation with minimal soft-tissue complications, but there is a paucity of data documenting the results of this technique. The purpose of this study was to prospectively determine the functional outcomes of treatment of unstable distal radial fractures with an intramedullary nail.
  
  
  METHODS
  Patients aged fifty years and older with a dorsally displaced unstable distal radial fracture--an extra-articular or simple intra-articular fracture--that was amenable to closed or percutaneous reduction were offered treatment with intramedullary nail fixation (MICRONAIL). Thirty-one patients were enrolled in the study, and twenty-nine patients with a mean age of sixty-seven years (range, fifty-one to eighty-five years) were available for one-year follow-up. According to the AO classification, there was one type-A2, twenty-four type-A3, and four type-C2 distal radial fractures. The patients were evaluated at six weeks, three months, six months, and one year after surgery. Outcome measures included standard radiographic parameters, active wrist range of motion, grip strength, a modified Mayo wrist score, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
  
  
  RESULTS
  At the final one-year follow-up evaluation, the active range of motion of the injured wrist relative to that on the uninjured side averaged 95% of flexion, 95% of extension, 93% of ulnar deviation, 91% of radial deviation, 99% of pronation, and 99% of supination. The mean grip strength was 96% of that on the uninjured side. According to the modified Mayo wrist score, there were twenty excellent and nine good results. The mean DASH score was 4.8 points. The final radiographic measurements demonstrated, on average, 25° of radial inclination, 11° of volar tilt, 10 mm of radial length, and +1 mm of ulnar variance. Loss of reduction occurred in two patients. One patient developed transient superficial radial sensory neuritis, which resolved within two months.
  
  
  CONCLUSIONS
  Intramedullary nailing can be a safe and effective treatment with minimal complications for dorsally displaced unstable extra-articular or simple intra-articular distal radial fractures.
authors.affiliation: Department of Orthopaedic Surgery, Ogikubo Hospital, Suginami-ku, Tokyo, Japan. nishiwa@jd5.so-net.ne.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Nishiwaki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tazaki
authors.forename: Hidenori
authors.initials: H
authors.lastname: Shimizu
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001858:Bone Nails; D004185:Disability Evaluation; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome