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Treatment of Distal Radial Fractures with an Intramedullary Nail
Masao Nishiwaki, MD, PhD1; Kenichi Tazaki, MD, PhD1; Asif M. Ilyas, MD2
1 Department of Orthopaedic Surgery, Ogikubo Hospital, 3-1-24 Imagawa, Suginami-ku, Tokyo 167-0035, Japan. E-mail address for M. Nishiwaki: E-mail nishiwa@jd5.so-net.ne.jp
2 The Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
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Based on an original article: J Bone Joint Surg Am. 2011;93:1436-41.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2011 Oct 26;01(03):e14 1-17. doi: 10.2106/JBJS.ST.K.00018
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This paper will describe the surgical technique for the treatment of unstable distal radial fractures with use of the MICRONAIL Intramedullary Distal Radius System (Wright Medical Technology, Arlington, Tennessee).

Step 1: Closed Reduction and Pinning

The fracture must be adequately reduced and pinned prior to nail insertion.

Step 2: Perform Exposure and Enter Canal

Protect the branches of the superficial radial sensory nerve at all times.

Step 3: Insert Nail and Distal Locking Screws

Insert the nail to a depth to place the most distal screw just proximal to the radiocarpal joint line; confirm fluoroscopically that the screw does not penetrate the articular surface.

Step 4: Insert Proximal Interlocking Screws and Close

Confirm that the proximal interlocking screws are bicortical for adequate fixation but are not too long.

Step 5: Postoperative Management

Use of a splint is followed by active and then passive range-of-motion exercises.


We reported a prospective analysis of patients treated for an unstable distal radial fracture with an intramedullary nail.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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