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Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures

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Abstract

Purpose

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.

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Acknowledgments

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedics, Imperial College NHS Trust, Praed St, Paddington, London, W2 1NY, UK

    John Hardman, Nawfal Al-Hadithy & Raymond Anakwe

  2. Kings College Hospital, Denmark Hill, London, SE5 9RS, UK

    Thomas Hester

Authors
  1. John Hardman
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  2. Nawfal Al-Hadithy
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  3. Thomas Hester
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  4. Raymond Anakwe
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Corresponding author

Correspondence to John Hardman.

Appendix 1

Appendix 1

Table 4 Search terms used to identify studies in the available literature
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Hardman, J., Al-Hadithy, N., Hester, T. et al. Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures. International Orthopaedics (SICOT) 39, 2381–2387 (2015). https://doi.org/10.1007/s00264-015-2763-1

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