title: Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures.
abstract: OBJECTIVE
  There remains little consensus regarding the optimal management of distal radius fractures. Fixed angle volar devices have gained recent popularity, but have also been associated with soft tissue complications. Intramedullary (IM) devices offer fixed angle stabilisation with minimally invasive surgical technique and low, IM profile. No formal review of outcomes could be identified.
  
  
  METHODS
  We conducted a systematic review of clinical studies regarding the use of fixed angle IM devices in acute extra-articular or simple intra-articular distal radius fractures. Preferred Reporting Items for Systematic Reviews (PRISMA) guidance was followed. Numerical data regarding functional scores, ranges of movement, radiological outcomes and complications were pooled to produce aggregate means and standard deviation.
  
  
  RESULTS
  A total of 310 titles and abstracts were identified. Fourteen papers remained for analysis. Total patient number was 357, mean age 63.72 years and mean follow-up 12.77 months. Mean functional scores were all rated as 'excellent'. Aggregate means: flexion 53.62°, extension 56.38°, pronation 69.10°, supination 70.29°, ulnar deviation 28.35°, radial deviation 18.12°, radial height 8.98 mm, radial inclination 16.51°, volar tilt 5.35°, ulnar variance 0.66 mm and grip strength 90.37 %. Overall complication rate was 19.6 %. Tendon rupture was unreported. Tendon irritation was 0.88 %. Radial nerve paraesthesia was 11.44 %.
  
  
  CONCLUSIONS
  Fixed angle IM devices facilitate excellent functional outcomes, with radiological and clinical parameters at least equivalent to volar plate devices. Low rates of tendon irritation and absence of tendon rupture are advantageous. Significant limitations include a lack of application for complex articular injuries and the propensity to cause a transient neuritis of the superficial branch of the radial nerve.
authors: Department of Trauma and Orthopaedics, Imperial College NHS Trust, Praed St, Paddington, London, W2 1NY, UK. john.hardman4@nhs.net.
authors: John
authors: J
authors: Hardman
authors: Department of Trauma and Orthopaedics, Imperial College NHS Trust, Praed St, Paddington, London, W2 1NY, UK.
authors: Nawfal
authors: N
authors: Al-Hadithy
authors: Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
authors: Thomas
authors: T
authors: Hester
authors: Department of Trauma and Orthopaedics, Imperial College NHS Trust, Praed St, Paddington, London, W2 1NY, UK.
authors: Raymond
authors: R
authors: Anakwe
mesh_terms: D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Distal radius fracture; Intramedullary fixation; Systematic review; Tendon rupture