Complications of intramedullary fixation for distal radius fractures, retrospective analysis using McKay's complication checklist.
Takuma Wakasugi, MD
Department of Orthopedic Surgery, Konan Hospital, Ibaraki, Japan
Intramedullary fixation for distal radius fractures was reported as a successful procedure that had comparable functional and radiographic outcomes with volar locking plate fixation. Intramedullary fixation for distal radius fractures is less invasive and is free from hardware irritation. But some specific complications such as radial nerve sensory neuritis were documented. Furthermore, there were no studies analyzing whether this less invasive technique could reduce the common complications associated with distal radius fractures.
We investigated complications of intramedullary fixation for distal radius fractures.
Patients and methods
We retrospectively investigated the medical records of 71 patients with distal radius fractures treated with an intramedullary implant (Micronail) followed-up more than 6 months. There were 48 AO A type fractures and 23 AO C type fractures. All fractures were caused by low energy injury. The patients included in this study were aged 50 years or older and the average age was 70.7 years old. The average follow-up period was 313 days. We investigated the neurological complications, tendinous complications, and skeletal and joint complications according to the complication checklist proposed by McKay.
As for neurological complications, 7 patients (9.9%) had radial nerve sensory disorder which resolved spontaneously. Two patients (2.8%) had carpal tunnel syndrome diagnosed clinically, which resolved spontaneously without the need for carpal tunnel release. As for tendinous complications, 3 patients (4.2%) had trigger finger at the A1 pulley, which needed injection of triamcinolone. There was no synovitis or tendon rupture around the fracture site. As for skeletal and joint complications, one patient (1.4%) treated with a relatively small sized implant had malunion after volar inclination of the intramedullary nail and distal fragment, which did not need corrective osteotomy because of good functional recovery after 1 year post-injury. The overall complication rate was 18%. There were no major complications which needed secondary surgical intervention such as hardware removal. At the final follow-up, the average Mayo modified wrist score was 92 points.
Intramedullary fixation for distal radius fractures was free from tendinous complications such as tenosynovitis and tendon rupture around the implant. This less invasive technique could not reduce common complications such as trigger finger and carpal tunnel syndrome associated with distal radius fractures. Radial nerve sensory disorder, a specific complication of intramedullary fixation, could be reduced by atraumatic nerve handling.
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