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Singh D, Singh A, Singh G, Singh M, Sandhu A, Sandhu KS. Comparative Study of the Management of Intertrochanteric Fracture Femur With Proximal Femoral Nail vs. the Dynamic Hipscrew With Derotation Screw in Elderly Population. Cureus 2021; 13:e19431. [PMID: 34926021 PMCID: PMC8654079 DOI: 10.7759/cureus.19431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Intertrochanteric fractures can be treated, both by conservative and operative methods depending upon the status of the patient. The purpose of this study was to assess the functional outcome of intertrochanteric fracture of femur treated with dynamic hip screw (DHS) with de-rotation screw comparing and proximal femoral nail (PFN). METHODOLOGY We compared 30 (male: 23, female: seven) cases of intertrochanteric fractures with a mean age of the population was 65 years and male to female ratio in was 2.75:1. Patients were recruited in this study having inclusion criteria of adults above 50 years of age, isolated intertrochanteric fractures of the AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1 and A2, fracture less than two weeks, and intertrochanteric fracture with or without distal extension. RESULTS Post-operatively, patients treated by either of these two methods were statistically analyzed in terms of comparing advantages and disadvantages in terms of the time of fracture union and outcome of both above-mentioned procedures using Harris hip score. CONCLUSION PFN gives better results than DHS with De-Rotation Screw-in intertrochanteric fractures in terms of the amount of blood loss during surgery, duration of surgery, early toe-touch weight-bearing, and Harris hip scores. There is no difference between the two modalities in terms of duration of hospitalization, fracture union, mortality and morbidity, and postoperative complications.
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Affiliation(s)
- Daljinder Singh
- Department of Orthopedics, Government Medical College, Patiala, IND
| | - Akashdeep Singh
- Department of Orthopedics, Gian Sagar Medical College, Mohali, IND
| | - Gitesh Singh
- Department of Orthopedics, Government Medical College, Patiala, IND
| | - Manjit Singh
- Department of Orthopedics, Gian Sagar Medical College, Mohali, IND
| | - Annie Sandhu
- Emergency Department, All India Institute of Medical Sciences, Rishikesh, IND
| | - Kuldip S Sandhu
- Department of Orthopedics, Government Medical College, Patiala, IND
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Chen ACY, Cheng CY, Weng CJ, Chou YC. Intramedullary nailing and plating osteosynthesis in the correction of post-traumatic deformity in late-diagnosed distal radius fractures: a retrospective comparison study. BMC Musculoskelet Disord 2019; 20:236. [PMID: 31113405 PMCID: PMC6530186 DOI: 10.1186/s12891-019-2605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Various surgical modalities are available for correction of deformity in late-diagnosed distal radius fractures. This study compared surgical outcomes between intramedullary nailing and plating osteosynthesis in open-wedge osteotomy. Methods We retrospectively reviewed 47 unilateral distal radius fractures that underwent open-wedge osteotomy at more than 4 weeks after injury between 2006 and 2011. A locally resected exuberant callus was used as the bone graft. Two types of fixation were used: intramedullary nail in 22 patients (group A) and locking plate in 25 patients (group B). Radiographic analysis including radial height, radial inclination, and volar tilt were performed preoperatively and 2-year postoperatively. The Modified Mayo Wrist Score (MMWS) was used for functional evaluation and a 10-point visual analog scale (VAS) for residual pain assessment. Patient satisfaction was self-reported as a 5-point scale. Radiographic data, functional outcomes, and surgical complications were compared between the two groups. Results All fractures achieved bone union without major complications. The MMWS averaged 84.8 ± 9.7 in group A and 85.2 ± 8.4 in group B, without significant differences (p = 0.436). Instead, significant differences were found in mean wrist flexion (73.6 ± 7.9 vs. 69.6 ± 7.8 degrees; p = 0.042), patient satisfaction (3.6 ± 1.1 vs. 2.9 ± 1.2; p = 0.034), postoperative radial height (11.6 ± 2.6 vs. 10.2 ± 3 mm; p = 0.039) and inclination (20.8 ± 2.8 vs. 17.7 ± 4.1 degrees; p = 0.004), and implant-related complications (9% vs. 36%; p = 0.03). There were no significant differences in other assessment items including postoperative grip strength, pain scale, supination/pronation/extension, volar tilt, correction angles of all three parameters, and general complication rate. Four patients in group A (18%) and 2 in group B (8%) experienced postoperative paresthesia of the surgical hand; no significant difference was noted. All except one patient in group B had full recovery of neurological symptoms. Conclusions Open-wedge osteotomy with either an intramedullary nail or locking plate fixation yielded encouraging radiographic and functional outcomes. Intramedullary nail fixation may facilitate restoration of radial height and inclination with better wrist flexion, less implant-related complications, and greater patient satisfaction.
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Affiliation(s)
- Alvin Chao-Yu Chen
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China. .,Chang Gung University College of Medicine, Taoyuan City, Taiwan.
| | - Chun-Ying Cheng
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chun-Jui Weng
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ying-Chao Chou
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Peterlein CD, Modzel T, Hagen L, Ruchholtz S, Krüger A. Long-term results of elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in children. Medicine (Baltimore) 2019; 98:e14743. [PMID: 30882642 PMCID: PMC6426625 DOI: 10.1097/md.0000000000014743] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Since its introduction by Metaizeau and Prevot, elastic-stable intramedullary nailing (ESIN) has been used for almost all diaphyseal fractures in children. Here, we present a retrospective study analyzing the long-term results of ESIN of forearm fractures in children.A total of 122 patients with diaphyseal forearm fractures and single subtypes in childhood were treated from 2000 to 2007 at our University Hospital by ESIN. At follow-up, the current conditions of the patients were evaluated using the Disabilities of Arm, Shoulder, and Hand (DASH) Score, and the Mayo Wrist score. Moreover, an individual questionnaire with 16 items was used to collect further information about the patient's condition and limitations as adults.The evaluation was performed at 12.4 years (average) after surgery. In our study population (n = 90), the average DASH scores for sports, performing arts, and work were 0.4 (standard deviation: 1.45), 0.9 (standard deviation: 5.68), and 0.3 (standard deviation: 7.39), respectively. Furthermore, 77% of our patients achieved a DASH Score of 0 (optimum outcome). The average Mayo Wrist Score was 97.64 (standard deviation: 7.39), and 82% of the study population achieved a score of 100 (optimum outcome). A correlation between the DASH and Mayo Wrist Scores was found in few patients. Overall, the DASH Score, Mayo Wrist Score, and results of our individual questionnaire demonstrated convincing point values.This study demonstrated favorable long-term results achieved by ESIN of forearm fractures in children. It seems that good outcomes, reported by various studies with short- to mid-term follow-up beforehand, do not deteriorate over time.Level of Evidence: Level III; retrospective study; therapeutic study.
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Affiliation(s)
| | | | - Lasse Hagen
- Center for Orthopaedics and Trauma Surgery, University Hospital Gießen and Marburg, Marburg
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Gießen and Marburg, Marburg
| | - Antonio Krüger
- Department of Trauma Surgery and Reconstructive Surgery, Diakonie Klinikum Jung-Stilling, Siegen, Germany
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Rancy SK, Malliaris SD, Bogner EA, Wolfe SW. Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant. J Wrist Surg 2018; 7:358-365. [PMID: 30349747 PMCID: PMC6196090 DOI: 10.1055/s-0038-1669438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3-20), VAS pain scores averaged 0.6 (range, 0-8) and PRWE averaged 12.1 (range, 0-53.5). Grip strength of the operated hand averaged 58 lbs (range, 20-130). ROM included: wrist flexion 73° (50-95), wrist extension 78° (60-110), pronation 77° (60-90), supination 79° (60-90), ulnar deviation 31° (5-45), and radial deviation 17° (10-30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.
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Affiliation(s)
| | - Stephanie D. Malliaris
- Division of Hand and Upper Extremity Surgery, Denver Health Medical Center, University of Colorado School of Medicine, University of Colorado Denver, Denver, Colorado
| | - Eric A. Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Zhang B, Chang H, Yu K, Bai J, Tian D, Zhang G, Shao X, Zhang Y. Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:2161-2169. [DOI: 10.1007/s00264-017-3460-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
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Wang J, Zhang L, Ma J, Yang Y, Jia H, Ma X. Is intramedullary nailing better than the use of volar locking plates for fractures of the distal radius? A meta-analysis of randomized controlled trials. J Hand Surg Eur Vol 2016; 41:543-52. [PMID: 26858306 DOI: 10.1177/1753193415625606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/10/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We conducted a meta-analysis of randomized controlled trials that compared the use of intramedullary nails and volar locking plates in distal radial fractures. PubMed, EMBASE and the Cochrane Collaboration Central database were used to find randomized controlled trials that met the eligibility criteria. Two reviewers screened the studies, extracted the data, evaluated the methodological quality and analysed the data with RevMan 5.1 software. No statistically significant differences were detected in the disability of the arm, shoulder and hand and the Gartland and Werley scores, radiographic parameters, wrist range of motion, grip strength, total complication rate and incidence of tendon rupture between the two groups. However, carpal tunnel syndrome occurred less often after intramedullary nailing. The two fixation methods achieved equal clinical, functional and radiological outcomes for primary fixation of the indicated types of distal radial fractures. LEVEL OF EVIDENCE Therapeutic/LevelI.
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Affiliation(s)
- J Wang
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - L Zhang
- Health Management Center, Beichen Hospital, Tianjin, China
| | - J Ma
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - Y Yang
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - H Jia
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - X Ma
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
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Vlček M, Jaganjac E, Pech J, Jonáš D, Kebrle R. Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures? Bosn J Basic Med Sci 2015; 14:81-8. [PMID: 24856379 DOI: 10.17305/bjbms.2014.2268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE OF THE STUDY Can minimally invasive intramedullary osteosynthesis of distal radius fractures provide better therapeutic results than multidirectional locking plates. Retrospective study of 68 patients operated for distal radius fractures, 18 were treated with intramedullary X-screw (XSCR) fixation and 50 with the multidirectional angle-stable plate system (APTUS). The evaluation at 1-year follow-up included functional status of the wrist and hand, and radiographic findings. In the XSCR group, the functional outcomes of the treated extremity did not achieve values comparable with those of the uninjured side in any of the parameters measured. The radiographic findings did not meet the requirements of successful healing due to failure to restore an anatomical volar tilt in 22.2% cases. In the APTUS group, comparable values of the injured and the uninjured side were achieved in radial deviation, ulnar deviation, pronation, supination and grip strength. The radiographic criteria of successful healing were met by all fractures treated by locking plate osteosynthesis. Implant migration associated with secondary displacement of bone fragments was recorded in 33.3 % of the XSCR patients and only in 4.0 % of the APTUS patients. The overall evaluation show that intramedullary osteosynthesis does not produce better treatment outcomes compared with plate osteosynthesis in indicated types of fractures.
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Affiliation(s)
- Martin Vlček
- Teaching Hospital Motol, 1st Clinic of Orthopaedic Surgery, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Edib Jaganjac
- Teaching Hospital Motol, 1st Clinic of Orthopaedic Surgery, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Jan Pech
- Teaching Hospital Motol, 1st Clinic of Orthopaedic Surgery, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - David Jonáš
- Teaching Hospital Motol, 1st Clinic of Orthopaedic Surgery, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Radek Kebrle
- Institut for Hand and Plastic Surgery Vysoké nad Jizerou, Dr. Farského 267, 512 11 Vysoké nad Jizerou, Czech Republic
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Distal radius: anatomical morphometric gender characteristics. Do anatomical pre-shaped plates pay attention on it? Arch Orthop Trauma Surg 2015; 135:133-9. [PMID: 25388864 DOI: 10.1007/s00402-014-2112-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of the study was to investigate differences in the osseous structure anatomy of male and female distal radii. METHODS Morphometric data were obtained of 49 distal human cadaveric radii. An imprint of the distal edge was attained using silicone mass and the palmar cortical angle (PCA) of the lateral and intermediate column, here declared as medial, according to the concept of Rikli and Rigazzoni. The lateral and medial length and five widths were digitally measured by three observers. In order to compare the measurements an unpaired t test was used. To prove the reliability of the measurements an intraclass correlation analyses was done. RESULTS Overall mean medial PCA was 148.25° (SD ± 6.83) and mean lateral PCA 156.07° (SD ± 7.00). In male specimens, the mean medial PCA was 147.38° (SD ± 6.01) and mean lateral PCA was 153.6° (SD ± 6.20) whereas in female specimens, the mean medial PCA was 149.41° (SD ± 7.79) and the mean lateral PCA 159.37° (SD ± 6.78), with statistical significance for the female lateral PCA. No gender significant difference for the medial PCA and no significant side difference for the PCA's could be found. The ICC of the observers was r = 0.936 and 0.976 for the medial and for lateral PCA 0.957-0.984. The palmar cortical length of the distal radius was significantly longer in male specimens. For all widths, larger values for male radii were measured, being statistically significant in all cases. CONCLUSION Male dimensions concerning the wide were significantly larger when compared with females. Regarding the PCA at the medial and lateral column, we found significant difference for lateral PCA concerning the gender. Overall, study results demonstrated an angle of 148.25° ± 6.83 for the medial PCA and 156.07° ± 7.00 for the lateral PCA.
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Oppermann J, Wacker M, Stein G, Springorum HP, Neiss WF, Burkhart KJ, Eysel P, Dargel J. Anatomical fit of seven different palmar distal radius plates. Arch Orthop Trauma Surg 2014; 134:1483-9. [PMID: 25108754 DOI: 10.1007/s00402-014-2072-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the anatomical fit of different, precontoured palmar distal radius plates. METHODS The anatomical fit of seven different types of palmar distal radius plates [Königsee variable fixed-angle radius plate 7/3-hole, Königsee variable fixed-angle radius plate 5/3-hole (Allendorf, Germany), Medartis 2.5 Adaptive TriLock, Medartis 2.5 TriLock, Medartis 2.5 TriLock extraarticular, (Basel, Switzerland), Synthes VA-LCP distal two-column-radius, Synthes LCP extraarticular (Bettlach, Switzerland)] were investigated in 25 embalmed human cadaveric radii. An imprint of the space between the well-positioned plate and the distal radius was attained using a silicone mass and the maximum height of the silicone imprint was digitally measured. The mean maximum imprint height was compared between the seven plates using an analysis of variance with repeated measures and Bonferroni correction for multiple comparisons. RESULTS The mean maximum distance between the plates and the radial cortex was <2 mm for all plates. The greatest difference was found with the Medartis Adaptive (1.99 ± 0.45 mm) and the least difference with the Synthes two-column (1.56 ± 0.76 mm), this difference being statistically significant (p = 0.005). CONCLUSION Although there was no complete congruency between the plates and the radial cortex, all distal palmar radius plates investigated in this study presented a reasonable anatomical shape. The Synthes VA-LCP distal two-column-radius plate palmar showed the best anatomical fit. A low profile and optimized anatomical precontouring minimizes irritation of the surrounding soft tissues and should be considered with plate design and implant choice.
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Affiliation(s)
- Johannes Oppermann
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany,
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Abstract
Surgical treatment options for distal radius fractures are many and commonly involve volar locked plating. More recently, newer volar locking plates have been introduced to the market that allow the placement of independent distal subchondral variable-angle locking screws to better achieve targeted fracture fixation. This article reviews this new technology and presents the authors' experience with the Aptus (Medartis, Kennett Square, Pennsylvania) variable-angle volar locking plates.
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Affiliation(s)
- Jung H Park
- Department of Orthopaedic Surgery, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA
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Abstract
Intramedullary fixation is the latest in a variety of techniques that have been developed to manage distal radius fractures. Intramedullary nailing of these fractures combines the soft-tissue advantages of a less invasive surgical approach with the biomechanical advantages of locking screw technology. These features may enable an accelerated postoperative rehabilitation and quicker return to function. Disadvantages associated with the intramedullary technique include the necessity of a closed or percutaneous reduction and the inability of the implant to adequately stabilize intraarticular or highly comminuted fractures. Consequently, intramedullary implants are primarily indicated for fixation of extra-articular or simple intraarticular split patterns and should not be employed for management of volar or dorsal shear fractures. Preliminary clinical data is emerging in the form of short-term follow-up studies with limited numbers of study participants.
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Affiliation(s)
- Kevin Harreld
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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