title: Comparative analysis of intramedullary nail fixation versus casting for treatment of distal radius fractures.
abstract: OBJECTIVE
  Intramedullary fixation is one treatment option for distal radius fractures. Our purpose was to compare the outcomes of intramedullary nailing to those of casting for these injuries.
  
  
  METHODS
  From 2006 to 2009, we reviewed 63 adult patients with isolated distal radius fractures. Thirty-one patients had surgical fixation with an intramedullary device (IMN group) within 4 weeks of the injury, and 32 (cast group) had casting as definitive treatment of the fracture. Clinical outcomes (grip strength; Disabilities of the Arm, Shoulder, and Hand scores; active wrist range of motion; and complications) and radiographic indices (radial inclination, radial height, ulnar variance, and tilt) of both groups were analyzed for the 1-, 2-, 4-, 6-, and 12-month follow-up periods.
  
  
  RESULTS
  The flexion-extension arc was significantly higher in the IMN group than in the cast group at 2-, 6-, and 12-month follow-up. The IMN group exhibited significantly greater grip strength and lower DASH scores throughout the follow-up period. At final follow-up, all radiographic indices were significantly better in the IMN group than in the cast group. There was no significant difference between the initial reduction to final position in the IMN group, but the cast group showed an increase in ulnar variance and a significant change in dorsal-volar tilt. In addition, the cast group experienced more clinical complications in the delayed period compared to the IMN group.
  
  
  CONCLUSIONS
  Intramedullary nail fixation, as compared to casting, results in less functional disability, not only in the early postoperative period but also up to a year after treatment. On the basis of our data, intramedullary fixation should be considered for patients with unstable extra-articular or simple intra-articular distal radius fractures.
authors.affiliation: Department of Orthopedics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA. tanvi@umdnj.edu
authors.forename: Virak
authors.initials: V
authors.lastname: Tan
authors.forename: Walter
authors.initials: W
authors.lastname: Bratchenko
authors.forename: Ali
authors.initials: A
authors.lastname: Nourbakhsh
authors.forename: John
authors.initials: J
authors.lastname: Capo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002370:Casts, Surgical; D004185:Disability Evaluation; D005260:Female; D005592:Fracture Fixation; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery*