European Orthopaedic Research Society, Bristol, September 2015

1. Intramedullary Nailing for
Distal Radius Fractures: A
Systematic Review
RW Jordan, A Saithna
Southport and Ormskirk Hospitals
NHS Trust, Merseyside, UK

2. 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

3. 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

4. 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%.

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