Treatment of distal radius fractures with percutaneous pinning and pin-in-plaster

A novel retractor-assisted closed reduction combined with percutaneous pinning fixation for the treatment of elderly distal radius fractures: a retrospective cohort study

Background

Percutaneous pinning fixation (PCP) has been used for the treatment of distal radius fractures for decades, especially in the elderly with fragile soft tissue. However, achieving and maintaining a sound anatomic reduction before PCP is difficult if we use the manipulative reduction method alone. Our study innovatively applied the Steinmann pin retractor for closed reduction combined with PCP, to provide a new protocol for the treatment of distal radius fractures.

Methods

From March 2017 to July 2018, 49 patients out of 57 that met the inclusion criteria but not the exclusion criteria were included in our retrospective cohort study. Sixteen patients were treated with Steinmann pin retractor-assisted closed reduction combined with PCP (S-PCP), and 19 patients were treated with the manipulative reduction combined with PCP (M-PCP), and 14 patients were treated with the manipulative reduction combined with cast splint (M-C). All these patients received a positive postoperative radiological and clinical evaluation.

Results

All the patients were followed up for a minimum of 2 years. The radiological parameters in each group improved significantly postoperative (posttreatment). In the S-PCP group, the values of radial height (postoperative, 13.33±1.74 mm; the first follow-up, 13.27±1.81mm; last follow-up, 13.16±1.76mm) and ulnar variance (postoperative, −0.10±1.29mm; the first follow-up, −0.05±1.27mm; last follow-up, −0.12±1.09mm) significantly improved as compared to the M-PCP and M-C groups. While the patients in the M-C group experienced significant re-displacement at the first and last follow-ups, in the S-PCP group, the range of wrist motion including extension (89.94±5.21%), radial deviation (90.69±6.01%), and supination (90.25±5.87%); ulnar deviation (89.81±5.82%) and QuickDASH score (2.70±3.64); and grip strength (92.50±5.59%), pronation (90.50±6.04%), and modified Mayo wrist score (90.94±4.17, the excellent rate reached up to 75%) also improved as compared to the M-PCP group, M-C group, or both groups at the last follow-up.

Conclusion

S-PCP improves fracture reduction and wrist function and can serve as an effective method for A₂(AO/OTA) and A₃ type of distal radius fractures in the elderly with limited dorsal comminution, including intra-articular fractures with displacement less than 2mm.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-021-02556-6.

Palmar-divergent dislocation of the scaphoid and lunate treated using percutaneous pinning and pin-in-plaster: A case report

Acute lunate and perilunate dislocations are not commonly observed injuries. In particular, palmar-divergent dislocation is a very rare injury with only a few cases reported in the literature. In this report, we describe the case of a 37-year-old patient with palmar-divergent dislocation of the scaphoid and lunate and discuss the mechanism of this type of injury. We also report a potential treatment for this pattern of palmar-divergent dislocation. The scapholunate and scaphocapitate joints were stabilized with K-wires and a modified pin-in-plaster fixation for 5 weeks after successful closed reduction. At the 1-year follow-up, magnetic resonance imaging showed no evidence of avascular necrosis of the scaphoid or lunate. However, radiographs showed mild dorsal intercalated segment instability deformity. The patient experienced no intermittent wrist pain or limitation in motion, with only 15% loss in grip strength. The Mayo wrist score was 90/100, and the patient resumed work as a craftsman. The carpal height ratio at the 4-year follow-up was 1.51 and 1.52 for the left and right wrists, respectively. In conclusion, we recommend this treatment method due to its benefits of being relatively simple, easy to perform, and having a relatively short operation time. Essentially, a good outcome was achieved using this method, including full range of motion and freedom from pain.

Introducing and Prospective Efficacy Comparison of an Innovative and Affordable Technique for the Treatment of Distal Radius Fractures

Background

There are different treatments as well as controversies surrounding the adequate treatment for Distal Radius Fractures (DRF). In the absence of enough evidence[HYPHEN]base data regarding clinical effectiveness of available treatments, cost should be considered as an essential factor in selecting the surgical technique for DRF treatment. The goal of this study is introducing an improved and modified pin[HYPHEN]and[HYPHEN]plaster (MP&P) technique as an affordable alternative for treatment of DRF. This study also assesses and compares the outcomes of DRF treatment by using the introduced method versus external fixation (EF) technique.

Methods

In this clinical cohort study, 98 patients presenting with closed DRF Types III or IV, randomly were classified into two modified P&P (50 patients) and EF (48 patients) groups and assessed for functional, clinical, radiographic and overall outcome at the time, 2, 10 and 22 months after surgery. They were also followed[HYPHEN]up for up to 3 years to determine the rate of complications.

Results

Eighty one percent of EF and 86% of MP&P group were female. The average ages in the EF and MP&P groups were 44.9 ± 12.4 and 46.1 ± 5.4, respectively. Around 70% of the patients in each group had a Type III fracture, and 30% had Type IV. The rate of complications was higher among EF group patients (seven major and seven minor complications) compared to the MP&P (only 4 minor complications), however the difference between two groups regarding the complications and treatment outcome were insignificant, except in extension ROM and the quick[HYPHEN]dash score (only in two and four months follow up visits) and also returning to work (only in two month follow up visit).

Conclusion

This study introduces a modified P&P technique that protects the transverse palmar curvature, prevents the collapse of the distal radius, and simplifies casting, thereby obviating a full arm cast and mitigating elbow stiffness in patient outcomes. This modified technique could be considered as a more cost[HYPHEN]conscious alternative to external fixation for patients with distal radius fractures.

Distal Radius Fractures: Evaluation of Closed Reduction and Percutaneous Kirschner Wire Pinning

Objective Closed reduction and percutaneous pinning (CRPP) is losing popularity as a treatment modality for distal radius fractures. However, in select cases, CRPP may have advantages relative to open reduction and internal reduction. We aimed to retrospectively assess the outcomes after CRPP for the treatment of distal radius fractures. Study Design This is a retrospective cohort study. Methods We used billing records to identify all skeletally mature patients with a distal radius fracture who were treated with CRPP by a single surgeon at a level I trauma center in an urban city in the United States. We assessed the medical charts and recorded demographics, trauma and treatment characteristics, radiographic characteristics, and outcomes. Results All patients had a good or excellent range of motion regarding forearm rotation, and almost 80% had good or excellent range of motion regarding flexion or extension of their wrist. One patient had a concern for pin tract infection, and one had subcutaneous migration of a pin, which were both treated by pin removal. Conclusion CRPP is a good option in patients with few and sizeable fracture fragments in patients with a distal radius fracture, and it should be considered as an effective tool to restore radiographic parameters and functional outcomes.

A prospective study of a modified pin-in-plaster technique for treatment of fractures of the distal radius

Objectives

There are various pin-in-plaster methods for treating fractures of the distal radius. The purpose of this study is to introduce a modified technique of ‘pin in plaster’.

Methods

Fifty-four patients with fractures of the distal radius were followed for one year post-operatively. Patients were excluded if they had type B fractures according to AO classification, multiple injuries or pathological fractures, and were treated more than seven days after injury. Range of movement and functional results were evaluated at three and six months and one and two years post-operatively. Radiographic parameters including radial inclination, tilt, and height, were measured pre- and post-operatively.

Results

The average radial tilt was 10.6° of volar flexion and radial height was 10.2 mm at the sixth month post-operatively. Three cases of pin tract infection were recorded, all of which were treated successfully with oral antibiotics. There were no cases of pin loosening. A total of 73 patients underwent surgery, and three cases of radial nerve irritation were recorded at the time of cast removal. All radial nerve palsies resolved at the six-month follow-up. There were no cases of median nerve compression or carpal tunnel syndrome, and no cases of tendon injury.

Conclusion

Our modified technique is effective to restore anatomic congruity and maintain reduction in fractures of the distal radius.

Cite this article: Bone Joint Res 2015;4:176–180

Outcomes of percutaneous pinning in treatment of distal radius fractures

Distal radius fractures are among the most common bone fractures all over the world. Close reduction and fixation by percutaneous pinning is a less invasive method comparing with other open surgeries. This study aims at evaluating the functional outcome of this treatment in distal radius fractures. In this prospective study, 50 patients with distal radius fractures underwent percutaneous pinning during a 16 month period in Tabriz Shohada Hospital. Follow-up for 3 months was possible in 48 (96%) patients. Possible complications (such as infection, nonunion, pin loosening and pain), functional outcomes (including range of motion, grip and pinch strengths) and radiological outcome were documented in intervals during follow-up. Forty eight patient, 22 males and 27 females with a mean age of 47.1 +/- 13.7 (19-80) years were enrolled. Local pain, infection and pin loosening were documented in 14.6, 16.7 and 2.1% of cases, respectively. Based on radiological reports, unacceptable palmar tilt, articular step, radial inclination and radial shortening were present in 6.3, 0, 2.1 and 6.3% of cases, respectively three months post-operation. The clinical outcomes according to Cooney's modification of the Green and O'Brien scheme were as excellent, good, fair and poor in 52.1, 31.3, 10.4 and 6.3% of cases, respectively. According to these results, closed reduction and percutaneous pinning of distal radius fractures is a rather successful method with minor complications.