What is the gold standard treatment for displaced fractures using the Metaizeau technique of retrograde intramedullary (IM) pinning?

From the Guidelines

The Metaizeau technique of retrograde intramedullary pinning is not explicitly mentioned as the gold standard for displaced fractures in the provided evidence, and its application may vary depending on the specific type of fracture and patient population. However, for certain types of fractures, such as diaphyseal fractures of the radius and ulna in children, intramedullary nailing techniques, including the Metaizeau technique, are considered effective treatments. The technique involves inserting a flexible intramedullary nail through a small incision near the distal metaphysis, advancing it retrograde through the medullary canal to stabilize the fracture. Key considerations in the management of fractures include minimizing morbidity, mortality, and improving quality of life, with surgical techniques like intramedullary nailing offering advantages over conservative management in terms of reduced morbidity and mortality, as seen in the treatment of extracapsular fractures where surgical fixation is preferred over conservative management due to its association with increased morbidity and mortality 1. In the context of long bone shaft fractures, osteosynthesis by intramedullary nailing or plate osteosynthesis is considered the definitive reference treatment, with the choice between these methods depending on various factors including the fracture pattern and patient condition 1. Given the importance of minimizing systemic inflammation and promoting early mobilization, techniques that preserve the periosteum and fracture hematoma, such as the Metaizeau technique, may offer benefits in terms of faster healing and reduced complication rates. Post-operative care typically involves immobilization in a cast for several weeks, followed by removal of the nail once radiographic healing is confirmed. The choice of surgical technique should be guided by the most recent and highest quality evidence, taking into account the specific characteristics of the fracture and the patient population, with the goal of optimizing outcomes in terms of morbidity, mortality, and quality of life. In the absence of direct evidence supporting the Metaizeau technique as the gold standard for all displaced fractures, clinicians should consider the principles of fracture management that prioritize early stabilization, minimal soft tissue disruption, and promotion of early mobilization, as these are associated with improved outcomes 1.

From the Research

Overview of the Metaizeau Technique

• The Metaizeau technique is a method of retrograde intramedullary pinning used to treat displaced radial neck fractures in children 2, 3, 4, 5, 6.
• This technique involves the insertion of a Kirschner wire or elastic nail into the distal radius and advancing it proximally to reduce and stabilize the fracture 3, 6.

Indications and Contraindications

• The Metaizeau technique is indicated for displaced radial neck fractures in children, particularly those with angulation greater than 30° 3, 4, 5.
• Contraindications include open fractures, fractures with significant comminution, and fractures with associated elbow instability 2, 3.

Surgical Technique

• The procedure is typically performed under general anesthesia with the patient positioned supine and the arm supported by an arm table or image intensifier 3.
• A radial approach is used to access the distal radius, and a Kirschner wire or elastic nail is inserted retrograde into the medullary canal 3, 6.
• The wire or nail is advanced proximally to engage the radial epiphysis, and the fracture is reduced by rotating the wire or nail 180° 3, 6.

Outcomes and Complications

• Studies have reported excellent or good outcomes in 80-90% of patients treated with the Metaizeau technique 3, 4, 5, 6.
• Complications include forearm compartment syndrome, malunion, nonunion, and osteonecrosis 2, 3.
• The use of fluoroscopy and careful attention to detail can help minimize the risk of complications 3, 6.

Comparison with Other Treatments

• The Metaizeau technique has been compared to other treatments, including open reduction and internal fixation, and has been shown to have similar or better outcomes in some studies 3, 5.
• The technique is considered a minimally invasive option with fewer complications than open reduction and internal fixation 2, 3.