***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Purpose C-type distal radial fractures remain challenging fractures . Currently locking plates are very popular because of their length preserving , stability . A considerable drawback is the high cost . Since 2003 we have been using mini AO plates ( 2.7 mm ) as an alternative . We analysed our results and performed a cost analysis . Methods Retrospective analysis was performed of all patients operated upon between 2003 and 2008 for C type distal radius fractures . Reduction was achieved with mini AO plates , applied in a buttress fashion , with ligamentotaxis . Rehabilitation consisted of immediate mobilisation . Pre- and postoperative X-rays , operative results and patient charts were review ed . Furthermore , we prospect ively evaluated the functional results using VAS , DASH and Mayo wrist scores . Lastly , we assessed the implant costs and compared them to locking plates . Results Thirty-four patients were treated with a mean age of 49 years . Mean radial shortening improved 2 mm ; dorsal and radial angulation improved 23 and 4 ° , respectively . At consolidation ( eight weeks ) the average radial shortening was 0.75 mm , a volar angulation of 3 ° , and 21 ° of radial angulation . Functional results were excellent , demonstrated by a mean VAS score less than 1 , a DASH score of 12 and a Mayo wrist score of 87 . Compared to locking plates , there was an overall reduction in material costs of 15,300 Euro . Conclusions Our technique has excellent biomechanical stability , enabling immediate functional rehabilitation , good anatomical and functional outcome with significantly lower costs BACKGROUND Intramedullary nailing for the treatment of unstable distal radial fractures is reported to provide stable fixation with minimal soft-tissue complications , but there is a paucity of data documenting the results of this technique . The purpose of this study was to prospect ively determine the functional outcomes of treatment of unstable distal radial fractures with an intramedullary nail . METHODS Patients aged fifty years and older with a dorsally displaced unstable distal radial fracture -- an extra-articular or simple intra-articular fracture -- that was amenable to closed or percutaneous reduction were offered treatment with intramedullary nail fixation ( MICRONAIL ) . Thirty-one patients were enrolled in the study , and twenty-nine patients with a mean age of sixty-seven years ( range , fifty-one to eighty-five years ) were available for one-year follow-up . According to the AO classification , there was one type-A2 , twenty-four type-A3 , and four type-C2 distal radial fractures . The patients were evaluated at six weeks , three months , six months , and one year after surgery . Outcome measures included st and ard radiographic parameters , active wrist range of motion , grip strength , a modified Mayo wrist score , and the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire . RESULTS At the final one-year follow-up evaluation , the active range of motion of the injured wrist relative to that on the uninjured side averaged 95 % of flexion , 95 % of extension , 93 % of ulnar deviation , 91 % of radial deviation , 99 % of pronation , and 99 % of supination . The mean grip strength was 96 % of that on the uninjured side . According to the modified Mayo wrist score , there were twenty excellent and nine good results . The mean DASH score was 4.8 points . The final radiographic measurements demonstrated , on average , 25 ° of radial inclination , 11 ° of volar tilt , 10 mm of radial length , and + 1 mm of ulnar variance . Loss of reduction occurred in two patients . One patient developed transient superficial radial sensory neuritis , which resolved within two months . CONCLUSIONS Intramedullary nailing can be a safe and effective treatment with minimal complications for dorsally displaced unstable extra-articular or simple intra-articular distal radial fractures We performed a prospect i ve , r and omised trial on 120 patients with redisplaced fractures of the distal radius comparing four methods of treatment . The four treatment groups , each containing 30 patients , were remanipulation and plaster , open reduction and bone grafting , and closed external fixation with and without mobilisation of the wrist at three weeks . The radiological results showed improvement in angulation of the distal radius for the open reduction and bone grafting group . Functional results at six weeks , three and six months and at one year , however , showed no difference between any of the four groups . The main influence on final outcome was carpal malalignment  which had a statistically significant negative effect on function Purpose This prospect i ve r and omized pilot study reports our institutional experience and early results using Sonoma Wrx ( Sonoma Orthopedic Products , Santa Rosa , CA ) in the treatment of extra-articular and simple intra-articular distal radius fractures . Material and methods A total of 64 patients , were enrolled in the study . They were considered eligible if they had ; unstable extra-articular distal radius fractures and simple intra-articular distal radius fractures suitable for closed reduction ( AO types ; A2.2 , A2.3 , A3.1 C2.1 , C2.2 ) . Patients in group I received intramedullary fixation using the Sonoma Wrx ® device and patients in group II received st and ard volar locking plate fixation . Radiographic criteria of acceptable healing were used for evaluation . Results Two groups were similar in terms of baseline characteristics . Mean time of operation was significantly shorter in Group 1 vs. in group 2 ( 36.81 ± 7.11 vs. 48.97 ± 5.9 minutes , p = 0.001 ) . Time to healing of the fracture was not different between two groups ( 5.45 ± 1.09 vs. 5.70 ± 1.04 weeks for Group 1 vs. 2 , respectively p = 0.36 ) . Overall complications occurred in 9 patients in group 1 and in 15 patients in group 2 ( p = 0.17 ) . Follow-up was completed in all patients with a median time of 12 months and 13 months in group 1 and 2 , respectively . On radiographic evaluation radial inclination , radial height and volar tilt were not significantly different between group 1 and 2 , respectively . There were no significant differences between two groups in regard to wrist rotational degrees measured in last follow-up visit . ConclusionS onoma Wrx Device is reliable and effective in terms of achieving satisfactory outcomes in treatment of distal radius fractures . It may be reasonable to use this device to prevent complications that are related to extensive soft tissue dissection The purpose of this prospect i ve , r and omized and blinded study was to compare the clinical outcomes of distal radial fractures treated with either an intramedullary nail or a volar locking plate .  Sixty two patients were enrolled in the study and r and omized to treatment with a MICRONAILTM ( Group 1 , 31 patients ) or an adaptive plate ( Group 2 , 31 patients ) . Fracture types included were unstable extra-articular metaphyseal distal radial fractures and simple or multifragmentary sagittal articular distal radial fractures ( AO classification types A2 , A3 , B1.1 and B1.2 ) . All patients were evaluated at 6 weeks , 3 months and 12 months after surgery . Outcome measures included st and ard radiographic parameters , active wrist range of motion , the disabilities of the arm , shoulder and h and ( DASH ) and Mayo wrist scores . We concluded that treatment of this subset of distal radius fractures with minimally invasive intramedullary nailing gives better clinical outcomes at 6 weeks after surgery than treatment with a volar locking plate . By 3 and 12 months following surgery , there are no significant differences in outcome between the two treatment methods . Disadvantages of the MICRONAIL ™ fixation system include risk of injury to the superficial branch of the radial nerve and a narrower spectrum of indications than volar locking plates Abstract This is a r and omised study to compare two types of osteo synthesis to mobilise wrists after distal fractures of the radius . Inclusion criteria were Older type 2 and 3 fractures .  External fixation was managed with Hoffmann II compact non-bridging . Internal fixation was managed with Micronail . Patients were followed up for 12 weeks . The primary outcome was the results of the disabilities of arm , shoulder and h and ( DASH ) question naire . The secondary outcomes were answers to the patient-rated wrist evaluation ( PRWE ) , grip strength , satisfaction , radial length , and volar tilt .  Thirty patients were r and omised to have external fixation and 31 to have internal fixation .  There were no significant differences in DASH score .  Internal fixation gave significantly better grip strength at five ( p = 0.00 ) and 12 weeks ( p = 0.03 ) . The operating time was significantly shorter ( p = 0.00 ) when non-bridging external fixation was used , and there were minor radiological differences . An activity-based costing analysis showed that external fixation  cost three times more overall Abstract To evaluate the results after fixation of distal radius fractures  using Micronail ® internal fixation , a prospect i ve cohort study was performed , including displaced fractures of the distal radius ( AO type A 2.2 , A3.1 , and A3.2 ) . In total , 60 patients were included and 44 patients were available for 1-year follow-up ( radiological and clinical examination ) and 39 for 5-year follow-up ( telephone interview ) . It was found that all fractures healed , with an average radial volar tilt of 2 ° , radial length of 11 mm , and a radial inclination of 22 ° . The functional result was excellent-to-good in 93 % of the patients . Thirteen patients ( 30 % ) reported paraesthesia of the superficial branch of the radial nerve at the 1-year follow-up . In four patients the paraesthesia of the radial nerve was persistent . No other complications or reoperations were reported by the patients at the 5-year follow-up and only one implant had been removed . The study confirms that the Micronail ® is a minimal invasive method that can provide a stable fixation of selected distal radius fractures and provide a good functional outcome with a very low need of implant removal after fracture healing with few complications related to the operation , the main complication being permanent damage to the radial nerve PURPOSE To determine whether volar locking plates are superior to external fixation with adjuvant pins in the treatment of unstable distal radius fractures . METHODS A total of 111 unstable distal radius fractures were r and omized to treatment with external fixation ( EF ) using adjuvant pins or with a volar locking plate ( VLP ) . The mean age of the patients was 54 years ( range , 20 - 84 y ) . Seven patients were lost to follow-up . At 1 year , 104 patients were assessed with a visual analog scale pain score , Mayo wrist score , Quick-Disabilities of the Arm , Shoulder , and H and ( QuickDASH ) , range of motion , and radiological evaluation . The QuickDASH score at 52 weeks was the primary outcome measure . RESULTS The operative time in the EF group was 77 minutes , compared with 88 minutes in the VLP group . At 52 weeks , patients with VLPs had a higher Mayo wrist score ( 90 vs. 85 ) , better supination ( 89 ° vs. 85 ° ) , and less radial shortening ( + 1.4 mm vs. + 2.2 mm ) . There were more patients with pain over the ulnar styloid in the EF group ( 16 vs 6 patients ) . For AO type C2/C3 , the patients with VLPs had better supination ( 90 ° vs. 76 ° ) and less ulnar shortening ( + 1.1 mm vs. + 2.8 mm ) . The complication rate was 30 % in the EF group , compared with 29 % in the VLP group . Eight ( 15 % ) plates were removed due to complications . The QuickDASH score was not significantly different between the groups . CONCLUSIONS Although we did not find a significant difference between the groups for the QuickDASH score , we believe that our results support the use of VLPs for the treatment of unstable distal radius fractures . A serious concern is that some patients will have to have their plates removed ; therefore , improving the surgical technique is important . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic BACKGROUND Intramedullary techniques for stabilization of displaced distal radius fractures are now available . Purported benefits include limited soft tissue dissection while affording sufficient stability to allow early wrist motion . The primary null hypothesis of this r and omized trial is that there is no significant difference with respect to functional outcome , pain and disability between patients treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation of unstable dorsally displaced extra-articular fractures of the distal radius . METHODS We conducted a single-centre , parallel-group trial , with unrestricted r and omization . Patients with dorsally displaced extra-articular distal radius fractures were r and omized to receive volar locking plate ( n=72 ) fixation or intramedullary nailing ( n=80 ) . The outcome was measured on the basis of the Gartl and and Werley and Castaing score ; the pain level ; the range of wrist motion ; the rate of complications ; and radiographic measurements including volar tilt and ulnar variance . Clinical and radiographic assessment was performed at 8 weeks , 6 months , 1 year and 2 years after the operation . RESULTS There were no significant differences between groups in terms of range of motion , grip strength or the level of pain during the entire follow-up period ( p>0.05 ) . There was no significant difference between treatment groups with respect to volar tilt or ulnar variance ( p 
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Conclusions Fixed angle IM devices facilitate excellent functional outcomes , with radiological and clinical parameters at least equivalent to volar plate devices .
Low rates of tendon irritation and absence of tendon rupture are advantageous .
Significant limitations include a lack of application for complex articular injuries and the propensity to cause a transient neuritis of the superficial branch of the radial nerve