A new technique in the treatment of distal radius fractures: the Micronail

Objective: In 2006, an intramedullar titanium osteosynthesis for the stabilization of distal radius fractures was introduced in The Netherlands: the Micronail®. The Micronail® can be used in approximately 30% of distal radius fracture treatments. This article presents the introduction of this new treatment, and first clinical results. Methods: In the first year after introduction of the Micronail® in our clinic, 10 patients have been treated with 11 Micronails® (eight 23-A2 radius fractures and three distal 22-A3 forearm frac¬tures). Our patients were mainly woman (n=9) and had a mean age of 81 years (range 69-88 years). After re-alignment of the fracture, the Micronail® was placed into the medulla through a small incision over the styloid process of the radius. By using a guidance system, three locking buttress screws were placed in the distal radial fragment and two locking bolts were placed in the proximal radius. Postoperative treatment consisted of a splint for 5 days, after which full load- carrying exercises can be started. Results: After 6 weeks, six patients had a full range of motion. Two patients were still in a cast because of secondary dislocation and CTS, respectively. One patient had a cast because of newly sustained trauma, which resulted in a peri-osteosynthetic fracture. Pain was not recorded in these patients. All fractures healed without major loss of alignment. Patients experienced good to excel¬lent results on an analog scale showing the wrist function. At 4 months, all patients had a good range of motion in the operated wrist; the difference between the two wrists was a maximum of 10°. Conclusion: The first results of Micronail® are promising. It has the advantages of other opera¬tive techniques (minimally invasive, stable, intramedullar) without their known disadvantages. Short immobilization is sufficient, after which full load-carrying exercises are indicated.