Abstract
BackgroundsTheaim of this study was to assess the efficacy of a modified intrafocal pinningtechnique with three-dimensional (3D) planning to facilitate volar plating in dorsally comminuted intra-articular distal radius fractures.MethodsIntotal 35 AO/OTA type C2 and C3 fractures were finally included.The 3D digital model of the fracture was reconstructed based on preoperative computedtomographic (CT) images, with the displacement of the comminuted dorsalfragment and the intra-articular fragment analyzed for preoperative planning. During operation, amodified intrafocal pinning technique was applied percutaneously from thedorsal aspect of the radius to reduce the collapsed intra-articular fragmentfollowing volar plating. Adequate reduction was confirmed in all of patientsconsidering radial height, radial inclination and volar tilt in postoperativeradiographs.ResultsNo significant fracture re-displacement wasobserved in most of the cases during a mean follow-up period of 17.4 months, exceptfor two patients withthe C3 fracture. All of the patients achieved adequate clinicalROMs at 12 months postoperatively, with a mean DASH score of 12.0. Most of the patients achievedan excellent (n = 21) or good (n = 12) Gartland and Werley wrist score.ConclusionsOurmodified intrafocal pinning technique with 3D planning contributes to a satisfactoryclinical and radiological outcome in dorsally comminuted intra-articular distalradius fractures fixed with a volar locking plate.TrialregistrationNotapplicable because the design of the study is retrospective.
Highlights
Distal radius fracture is the second most common fracture in the elderly
We present a modified intrafocal pinning technique with three-dimensional (3D) planning to facilitate the reduction and fixation of dorsally comminuted intra-articular distal radius fractures
From January 2017 to Dec 2018, 41 consecutive patients with dorsally comminuted intraarticular distal radius fractures were enrolled according to the inclusion criteria of (1) age between 18 and 70 years, (2) AO/OTA type C2 and C3 fractures, (3) with dorsal metaphyseal comminution, and (4) meeting the indications for open reduction and internal fixation (ORIF) recommended on the American Association of Orthopaedic Surgeons (AAOS) standard [11]
Summary
Distal radius fracture is the second most common fracture in the elderly. Dorsal comminution occurs in about 60 % of the distal radius fractures, which leads to a reduced stability of fracture fixation, and an increased probability of fracture re-displacement [1]. Recent studies confirmed the feasibility of the intrafocal pinning technique as a reduction tool for unstable intraarticular fracture of distal radius fixed with volar locking plate [3, 9, 10]. In these studies, the dorsal cortex was considered crucial for the successful buttress effect provided by the intrafocal K-wires. The application of the intrafocal pinning technique in dorsally comminuted intra-articular distal radius fractures has never been investigated. We present a modified intrafocal pinning technique with three-dimensional (3D) planning to facilitate the reduction and fixation of dorsally comminuted intra-articular distal radius fractures
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