• Maxence Thomas, Hidalgo Diaz Juan José JJ Department of Hand Surgery, SOS Main, CCOM, University of Strasbourg, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, 10, avenue Bauma, Guillaume Prunières, Sybille Facca, Yuka Igeta, and Philippe Liverneaux.
• Department of Hand Surgery, SOS Main, CCOM, University of Strasbourg, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France.
• Orthop Traumatol Sur. 2019 May 1; 105 (3): 409-415.

IntroductionThere are numerous internal fixation techniques for distal radius fracture, using pins, plates or nails. Some authors have developed minimally invasive procedures. The aim of the present study was to compare two minimally invasive internal fixation techniques for unstable extra-articular distal radius fracture in women over 50 years of age: volar plate (minimally invasive plate osteosynthesis: MIPO), and intramedullary nail.HypothesesThe main study hypothesis was that the incision scar left by minimally invasive internal fixation is smaller using MIPO than an intramedullary nail. The secondary hypotheses were that the two techniques do not differ in terms of pain, functional score, strength, range of motion and radiologic indices.Material And MethodThe series comprised nineteen A2.2 and one A2.1 fractures in 20 female patients with a mean age of 72 years. The first 10 (group 1) received minimally invasive internal fixation of the distal radius by MIPO, and the other 10 (group 2) by intramedullary nail locked onto the distal radius epiphysis and diaphysis.ResultsThe main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail (mean, 14.3mm vs. 32.8mm). Some of the secondary hypotheses were also confirmed: there were no differences between the two techniques in terms of pain at 6 months, QuickDASH, PRWE (Patient-Reported Wrist Evaluation), range of motion or ulnar variance; two were not confirmed: pain at 6 weeks was less with intramedullary nails, and palmar slope was better with MIPO.Discussion And ConclusionThe main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail. In conclusion, the present findings showed that internal fixation of unstable extra-articular fracture in over 50-year-olds gave better clinical results at 6 weeks using an intramedullary nail, while MIPO required smaller incision.Level Of EvidenceIII, retrospective study.Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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