Preoperative radiographs and CT scan demonstrated a multifragmentary intra-articular fracture of the distal radius. After confirming the position of the wires to be satisfactory on orthogonal radiographic views, the wires were cut and bent. A 0.045-in Kirschner wire was then placed from the die punch fragment across the fracture site into the proximal fragment to create an X-shaped construct. Dissection was performed carefully between the extensor tendons to expose the dorsal ulnar lip of the radius. In the patients who required additional wire placement in the die punch fragment (the dorsoulnar corner of the intermediate column), an additional incision was made distal and ulnar to the die punch fragment. After confirming the position of the first Kirschner wire to be satisfactory, this was usually augmented with a second wire placed in a similar fashion. An oscillating attachment was used for placement of all wires. Using a soft tissue protector, a 0.062-in Kirschner wire was placed initially from the tip of the radial styloid across the fracture site into the proximal fragment under direct vision. We then performed subcutaneous dissection to expose the tip of the radial styloid. After confirming that the fracture could be reduced anatomically, a small incision was made just distal to the tip of the radial styloid. The fractures that could not be reduced anatomically, including fractures affecting the volar lunate facet, were deemed to be unsuitable for this technique and were converted to ORIF. The distal radius fracture was reduced with a combination of traction, wrist flexion, and ulnar deviation. The pinning procedure was performed using mini C-arm image intensification ( We therefore aimed to retrospectively assess the outcomes after closed reduction and percutaneous Kirschner wire pinning for the treatment of distal radius fractures and to compare these with the results of previous studies.Īll patients were treated within the first 2 weeks after their injury. We noticed that the use of CRPP in our institutions is relatively unpopular compared with treatment of distal radius fractures by ORIF. This advantage will become more and more elemental as the treatment of distal radius fractures is increasingly challenging the financial allocations in health care, both due to aging population and the rising use of (costly) ORIF as a primary treatment modality.ĭespite these advantages and despite evidence suggesting superior results of CRPP compared with plaster casting, The advantages that CRPP can have relative to ORIF in selected fractures seem to play a subordinate role in surgical decision making, as CRPP appears to be losing popularity among surgeons.Īpart from being less invasive and possibly a technically less demanding procedure compared with ORIF, CRPP also seems to be more economical than ORIF. It is acknowledged that different fracture types of the distal radius merit different fixation methods, but specific recommendations based on fracture type are unavailable due to the absence of convincing scientific evidence.ĭespite the absence of a consistent treatment algorithm for distal radius fractures, there seems to be a collective tendency among orthopaedic trauma surgeons to treat distal radius fractures with open reduction and internal fixation (ORIF)-even though ORIF does not always seem to result in superior long-term results when compared with closed reduction and percutaneous pinning (CRPP),Īnd the results of CRPP are comparable to those of ORIF. One patient had a concern for pin tract infection, and one had subcutaneous migration of a pin, which were both treated by pin removal.ĬRPP 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. We assessed the medical charts and recorded demographics, trauma and treatment characteristics, radiographic characteristics, and outcomes.Īll 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. 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 aimed to retrospectively assess the outcomes after CRPP for the treatment of distal radius fractures. However, in select cases, CRPP may have advantages relative to open reduction and internal reduction. Closed reduction and percutaneous pinning (CRPP) is losing popularity as a treatment modality for distal radius fractures.
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