The NX Nail System 

A 25-year-old right-hand-dominant male presented with a high energy injury to the right wrist after a motorcycle accident. X-rays showed fractures of the distal radius, distal ulna, scaphoid and hook of hamate. The patient was treated with a combination of the Field Orthopaedics 4.0mm NX Extremity Nail to provide fixation to the distal ulna, a dorsal bridge plate to temporarily stabilize and maintain the length of the distal radius and parallel headless compression screws with bone graft for the scaphoid waist fracture.

A 25-year-old right-hand-dominant female presented to Dr Wurapa three days after being involved in a motor vehicle accident. X-rays showed unstable fracture patterns involving the third and fourth metacarpal shafts. Given her young age, dominant hand involvement and fracture patterns; reduction and fixation was recommended and achieved with the NX Nail.

A 56-year-old female presented to Dr Grier after sustaining an injury to her left hand while riding an E-bike. Radiographs confirmed a spiral fracture of the fourth metacarpal diaphysis with displacement in both the coronal and sagittal planes. With a desire to return to her active lifestyle and a concerning degree of malrotation present, the decision was made to stabilise the fracture with an NX Nail from Field Orthopaedics. At follow-up the patient demonstrated full active range of motion of the ring finger, was able to make a fist and had all motor function intact. With preserved implant alignment and no evidence of hardware failure, the patient was able to resume normal function without restriction. 

A 20-year-old female professional Australian Football League (AFLW) player suffered an injury to the ring finger of her dominant right hand in a collision at training. She was seen by Dr Couzens the next day and presented with pain, swelling and an angulated finger. Radiographs showed a comminuted fracture of the middle P2 phalanx. Dr Couzens achieved definitive fixation with a 2.0mm x 22mm NX Nail through a percutaneous approach. The operative finger was buddied to the middle finger initially and the patient was seen by a hand therapist for provision of a training and playing splint. By six weeks she was cleared to return to contact ball work with no restrictions in the gym. In this instance, Dr Couzens was able to treat a painful and debilitating injury for a young patient whose vocation requires the full use of her hand and fingers.

A 25-year-old male presented to the local emergency department for treatment of a painful and swollen right hand after a fall. Upon review by Dr Wurapa six days later, radiographs revealed a displaced shaft fracture of the fourth metacarpal. Incidentally, there was a small plate present on the fifth metacarpal in the same hand from a prior remote injury. With the patient adamant to avoid the painful and prolonged recovery he had previously experienced, Dr Wurapa opted for a 3.5mm diameter, 50mm length NX Nail to provide definitive fixation. Six days postoperatively the patient had good hand motion and was given a splint to aid in his return to work. By eight weeks he reported no pain or functional limitations. In this case, Dr Wurapa was able to treat a young patient who was keen to return to work with a superior alternative to plate fixation. 

A 37-year-old male sustained a crush injury to his non-dominant hand at work. He was initially evaluated at a local emergency department before presenting to Dr Wurapa three days later. Upon evaluation, he had a dorsal laceration and a fifth metacarpal fracture of the right hand which involved the distal diaphysis with comminution. After discussing operative and nonoperative treatment options for the fracture, the patient elected to proceed with open reduction internal fixation to minimize limitations during his recovery and return to work. Dr Wurapa achieved definitive fixation with a 4.0mm diameter, 45mm length NX Nail following debridement and repair of the dorsal wound. By four weeks post-operatively the patient reported no pain, had weaned splint use, and returned to normal daily activities and work tasks with full digital motion. At his final appointment he was deemed to have completed a full clinical recovery with solid consolidation at the fracture site. In this case, the NX Nail offered Dr Wurapa a solution for treating a complex fracture while maintaining length, restoring version, and controlling angulation1 .