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Percutaneous pinning of distal radius fractures restores motion over long-term

The minimally invasive technique bucks the popular trend toward ORIF.

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SEATTLE — Two- and three-part distal radius fractures were effectively treated with closed reduction and percutaneous pinning, with patients experiencing few complications, according to a study by hand surgeons from New York.

For the retrospective review, investigators compared various wrist parameters in both the treated and untreated wrists of 45 patients who averaged 57.3 years of age. These patients had 46 fractures classified as AO type A2, A3, C1 or C2.

All patients had at least 21 months follow-up. At 52.7 months mean follow-up, investigators noted no statistically significant differences between extension, pronation and radial and ulnar deviation on the two sides.

"The only significant differences we found were wrist flexion and supination," said Louis W. Catalano, MD, who presented the results at the American Society for Surgery of the Hand 62nd Annual Meeting, here.

The differences in flexion and supination were 5° and 4°, respectively, Catalano said. Grip strength was similar between the injured and uninjured wrists, he said.

The Disabilities of the Arm, Shoulder and Hand (DASH) score averaged 9.7 points in the treated wrists, which compared favorably to the average score of 9 points in healthy volunteers, Catalano said.

Investigators used a closed technique to pin the fractures by placing a minimum of two pins obliquely through the radial styloid via a small incision. They also placed another pin at the dorsal end of the distal radius, just distal to Lister's tubercle.

This is "one of the things we have been doing for a long time at our center, which we have not abandoned in the face of the trend toward open reduction internal fixation (ORIF)," Steven Z. Glickel, MD, one of the study's investigators, told Orthopedics Today prior to the meeting.

However, the technique has the drawback of precluding early movement, he said.

For more information:

• Catalano LW, Raia F, Glickel SZ, et al. Long-term outcome assessment for closed reduction and percutaneous pinning of distal radius fractures. #LR-4. Presented at the 62nd Annual Meeting of the American Society for Surgery of the Hand. Sept. 27-29, 2007. Seattle.