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Introduction: The use of minimally invasive techniques for the treatment of the distal radius fractures has been increasing significantly over the past three years. This increase can be explained by the rising incidence of fractures in economically active patients and their need to early return to work activities. Objective: To analyze the clinical and functional results of patients diagnosed with distal radius fracture with reducible and unstable deviation, who underwent surgical treatment by the minimally invasive percutaneous osteosynthesis technique using a locked intramedullary nail. Methods: We evaluated 53 patients who underwent surgical treatment of reducible and unstable distal radius fractures, classified according to Rayhack as type IIB, using the minimally invasive method with intramedullary locked nail in the period between January 2011 and December 2012. The follow-up time was 6 to 24 months, periodically evaluating radiographic parameters, pain, range of motion, grip strength and quality of life through the DASH questionnaire. Results: Through the analysis of data obtained, we observed a statistically significant improvement in all clinical parameters analyzed. The degree of grip strength and range of motion presented an important improvement since the third week of the postoperative period, so did the pain scales and evaluation through the DASH questionnaire. Conclusion: The minimally invasive technique is a safe and effective procedure, presenting clinical and functional improvement and presenting superior results when compared to other methods described on the literature.
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Alffram PA, Bauer GC. Epidemiology of fractures of the forearm. A biomechanical investigation of bone strength. J Bone Joint Surg Am. 1962;44-A:105-14.
Angelini LC, Grecco MAS. Tratamento da pseudartrose do terço distal do rádio. Acta Ortop Bras. 2005;13(2):95-99. http://dx.doi.org/10.1590/S1413-78522005000200006
Fernandez DL, Palmer AK. Fractures of the distal radius. In: Green DP, Hotchkiss RN, Pederson WC, editors. Green's operative hand surgery. 4th ed. New York: Churchill Livingstone; 1999. p. 925-85.
Wei DH, Poolman RW, Bhandari M, Wolfe VM, Rosenwasser MP. External fixation versus internal fixation for unstable distal radius fractures: a systematic review and meta-analysis of comparative clinical trials. J Orthop Trauma. 2012;26(7):386-94. http://dx.doi.org/10.1097/BOT.0b013e318225f63c
Nishiwaki M, Tazaki K, Shimizu H, Ilyas AMJ. Prospective study of distal radial fractures treated with an intramedullary nail. Bone Joint Surg Am. 2011;93(15):1436-41. http://dx.doi.org/10.2106/JBJS.J.01159
Sen MK, Strauss N, Harvey EJ. Minimally invasive plate osteosynthesis of distal radius fractures using a pronator sparing approach. Tech Hand Up Extrem Surg. 2008;12(1):2-6. http://dx.doi.org/10.1097/BTH.0b013e3180cac281
Handoll HH, Madhok R. WITHDRAWN: surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2009;(3):CD003209. http://dx.doi.org/10.1002/14651858.CD003209.pub2
Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;(3):CD003209. http://dx.doi.org/10.1002/14651858.CD003209
Rayhack, JM. The history and evaluation of percutaneous pinning of displaced distal radius fractures. Orthop Clin North Am. 1993;24(2):287-300.
Jester A, Harth A, Wind G, Germann G, Sauerbier M. Disabilities of the arm, shoulder and hand (DASH) questionnaire: determining functional activity profiles in patients with upper extremity disorders. J Hand Surg Br. 2005;30(1):23-8. http://dx.doi.org/10.1016/j.jhsb.2004.08.008
Schønnemann JO, Hansen TB, Søballe K. Randomised study of non-bridging external fixation compared with intramedullary fixation of unstable distal radial fractures. J Plast Surg Hand Surg. 2011;45(4-5):232-7. http://dx.doi.org/10.3109/2000656X.2011.613243
Mehling I, Müller LP, Delinsky K, Mehler D, Burkhart KJ, Rommens PM. Number and locations of screw fixation for volar fixed-angle plating of the distal radius fracture: biomechanical study. J Hand Surg Am. 2010;35(6):885-91. http://dx.doi.org/10.1016/j.jhsa.2010.03.027
McQueen MM. Redisplaced unstable fractures of the distal radius. A randomised, prospective study of bridging versus non-bridging external fixation. J Bone Joint Surg Br. 1998;80(4):665-9.
Wolfe SW, Austin G, Lorenze M, Swigart CR, Panjabi MM. A biomechanical comparison of different wrist external fixators with and without K-wire augmentation. J Hand Surg Am. 1999;24(3):516-24. http://dx.doi.org/10.1053/jhsu.1999.0516
Yamako G, Ishii Y, Matsuda Y, Noguchi H, Hara T. Biomechanical characteristics of nonbridging external fixators for distal radius fractures. J Hand Surg Am. 2008;33(3):322-6. http://dx.doi.org/10.1016/j.jhsa.2007.09.019
Cui Z, Pan J, Yu B, Zhang K, Xiong X. Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis. Int Orthop. 2011;35(9):1333-41. http://dx.doi.org/10.1007/s00264-011-1300-0
Zenke Y, Sakai A, Oshige T, Moritani S, Fuse Y, Maehara T, et al. Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis. J Orthop Trauma. 2011;25(7):425-31.http://dx.doi.org/10.1097/BOT.0b013e3182008c83
Orbay JL, Badia A, Indriago IR, Infante A, Khouri RK, Gonzales E, et al. The extended flexor carpi radialis approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg. 2001;5(4):204-11.
Richard MJ, Wartinbee DA, Riboh J, Miller M, Leversedge FJ, Ruch DS. Analysis of the complications of palmar plating versus external fixation for fractures of the distal radius. J Hand Surg Am. 2011;36(10):1614-20. http://dx.doi.org/10.1016/j.jhsa.2011.06.030
Rampoldi M, Marsico S. Complications of volar plating of distal radius fractures. Acta Orthop Belg. 2007;73(6):714-9.