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Complications of Intramedullary Fixation for Distal Radius Fractures in Elderly Patients: A Retrospective Analysis
Takuma Wakasugi1, Ritsuro Shirasaka1, Toshiyuki Kawauchi1
1* Department of Orthopedic Surgery, Tsuchiura Kyodo Hospital, Ibaraki, Japan.
Background:
Intramedullary fixation for distal radius fractures is reported to be free of hardware irritation and less invasive than other fixation methods. Some specific complications associated with intramedullary fixation, such as radial nerve sensory neuritis, have been reported, but no study has focused on the complication rates of intramedullary fixation for distal radius fractures in the elderly population. Furthermore, no studies have analyzed common complications, such as carpal tunnel syndrome and flexor tenosynovitis including trigger finger, among patients with distal radius fractures treated by intramedullary fixation based on a comprehensive complication checklist.
Methods:
We reviewed the medical records of 52 elderly patients with distal radius fractures treated with intramedullary nail fixation. We investigated the postoperative complications in these patients using McKay's complication checklist.
Results:
5 patients experienced radial nerve sensory disorder, and one patients developed carpal tunnel syndrome. All neurological symptoms resolved spontaneously, and these neurological complications were categorized as mild. Further, 3 patients developed trigger finger at the A1 pulley and needed triamcinolone injections for symptomatic relief. There were no tendinous complications around the implanted hardware. All tendinous complications were categorized as moderate complications and resolved with steroid injection therapy. Among skeletal complications, 1 case of postoperative volar displacement resolved with good functional outcome without the need for corrective osteotomy. This was considered a mild complication. The total complication rate was 19.2%. All complications were categorized as mild or moderate, and no patients experienced severe complications that needed further surgery such as hardware removal.
Conclusions:
Intramedullary fixation for distal radius fractures was free from tendinous complications such as tenosynovitis and tendon ruptures around the implant, which are frequently caused by volar locking plate fixation. However, this less invasive technique could not avoid common complications such as trigger finger and carpal tunnel syndrome associated with distal radius fractures.
Insights
Intramedullary fixation for elderly distal radius fractures showed a 19.2% complication rate, mainly mild neurological issues and trigger finger. This method avoids implant-related tendon problems but does not prevent carpal tunnel syndrome.
Area of Science:
- Orthopedic surgery
- Geriatric trauma care
- Fracture fixation techniques
Background:
- Intramedullary fixation is less invasive for distal radius fractures.
- Limited data exists on elderly patient complications with this method.
- Previous studies haven't comprehensively analyzed common issues like carpal tunnel syndrome.
Purpose of the Study:
- To evaluate complication rates of intramedullary fixation for distal radius fractures in elderly patients.
- To analyze specific complications using a detailed checklist.
Main Methods:
- Retrospective review of 52 elderly patients with distal radius fractures.
- Treatment involved intramedullary nail fixation.
- Complications assessed using McKay's complication checklist.
Main Results:
- Overall complication rate was 19.2%.
- Mild neurological complications (radial nerve sensory disorder, carpal tunnel syndrome) and trigger finger were observed.
- No implant-related tendinous complications or severe outcomes requiring surgery occurred.
Conclusions:
- Intramedullary fixation is free of implant-associated tendinous complications in elderly distal radius fractures.
- The technique does not prevent common issues like trigger finger and carpal tunnel syndrome.
- Complications were mild to moderate, with no severe cases needing hardware removal.