Intramedullary fixation has recently received increased enthusiasm as an option for distal radius fracture fixation. Indications for this fracture fixation technique should be limited to predominately displaced extra-articular or simple intra-articular distal radius fractures. Intramedullary fixation permits limited soft tissue dissection and insertion of a low-profile implant that acts as an internal splint. Purported benefits include a familiar fracture fixation technique, less soft tissue irritation, and locked fixed-angle technology. Thorough understanding of the radial and dorsal approaches to the distal radius is a prerequisite. Important aspects of intramedullary fixation of distal radius fractures include proper fracture selection, good fracture reduction, protection of sensory nerves, and avoidance of inadvertent intra-articular screw placement. Relevant surgical anatomy, technique, postoperative care, and a review of complications are presented. (J Hand Surg 2009;34A:341-346. (C) 2009 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)
