Abstract
BackgroundPercutaneous 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.MethodsFrom 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.ResultsAll 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.ConclusionS-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.
Highlights
Distal radius fractures are common upper limb fractures with up to 18% incidences in the elderly [1]
This brings about risks to open reduction and internal fixation (ORIF)
Percutaneous pinning fixation (PCP) has the following advantages: low-cost treatment, minimally invasive, and early removal of fixation at 6 weeks postoperative. The challenge this protocol faces is that achieving and maintaining a sound anatomic reduction before PCP when the manipulative closed reduction method alone is used is difficult. This new protocol (Steinmann pin retractor-assisted closed reduction) which has not been previously reported was used before PCP (S-PCP)
Summary
Distal radius fractures are common upper limb fractures with up to 18% incidences in the elderly [1]. Most of them are unstable fractures that must be treated with a surgical procedure These elderly patients usually come in with pre-existing hypertension, diabetes, or other complicated diseases which makes the soft tissue at the fracture end very fragile. This brings about risks to open reduction and internal fixation (ORIF). PCP has the following advantages: low-cost treatment, minimally invasive, and early removal of fixation at 6 weeks postoperative The challenge this protocol faces is that achieving and maintaining a sound anatomic reduction before PCP when the manipulative closed reduction method alone is used is difficult. 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
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