Minimally invasive flexible insertion and rigid intramedullary nail fixation for distal radius fractures

Intramedullary (IM) devices are currently available for the surgical treatment of various distal radius fractures. The proposed advantages of IM fixation include minimally invasive operative techniques, less opportunity for hardware irritation, decreased postoperative pain, and stable fixation allowing for early range of motion. However, many complications have been reported with the use of IM devices in the distal radius such as injury to the superficial branch of the radial nerve, screw penetration into the distal radial ulnar joint, and loss of reduction. Nonetheless, early clinical reports of IM fixation for purely extra-articular distal radius fractures (AO type 23-A) and those with simple intra-articular extension (AO type 23-C1 and C2) have been promising. The purpose of this article is to describe the indication, technique, and rehabilitation after IM nail fixation for select distal radius fractures with a novel IM device, which provides locked fixed angle distal screws to support the articular subchondral bone and a unique flexible IM component that conforms to the patient's anatomy, is made rigid, and locks proximally with IM fixation within the radial diaphysis. This unique device is theorized to be more patient specific (due to the flexible portion of the nail) and further minimize soft tissue irritation compared with those IM devices currently available.