Comparison between results of management of recent intra-articular fractures of distal end radius by percutaneous pinning and volar locked plate

Abstract

Introduction Distal radius fractures are considered the most common fractures in orthopedic practice. There are many different fracture patterns and injuries associated with articular cartilage and neighboring soft tissue that are found in different patient populations. Fractures of the distal radius are caused by high-energy trauma in young patients and by low-energy trauma in the elderly. Disruption of the ligaments and the displacement of the carpus and/or the triangular fibrocartilage complex will equally influence the functional outcome. Many methods have been established for the treatment of fractures of the distal radius. The main principle is to obtain anatomical reduction with rigid fixation to allow early mobilization. Comparison between the results of closed reduction and internal fixation by percutaneous Kirschner wires and open reduction and internal fixation (ORIF) by self-locked plates and screws in the treatment of recent intra-articular distal radial fractures was made in 30 patients in El-Menoufia University Hospital during a 33-month period. Objectives This study compared clinical outcomes and complications in patients with recent intra-articular distal radius fractures treated using two methods of fixation: percutaneous pinning and self-locked plating. Background While selecting treatment, a technique that makes alignment of articular surfaces a priority and restores more normal joint mechanics should be used. Closed reduction and percutaneous pinning is a good option, which preserves soft tissue as it is a minimal invasive procedure. On the other hand, open reduction and self-locked plate fixation is a unique option in supporting articular surface and preventing its collapse. Materials and methods Thirty patients were analyzed and divided into two groups. Patients in group A (n = 17) were treated with percutaneous pinning and patients in group B (n = 13) were treated with ORIF by self-locked plating. The major characteristics of the two groups in terms of age, sex, mode of injury, fracture location, and associated injuries were similar. Results Primary union was achieved in all patients. The mean time to union was similar in the two groups. The mean operation time in the percutaneous pinning group (25 min) was shorter than that in the ORIF group (80 min). There were complications in four cases (13.33%). One case was treated by self-locked plates and screws and had extensor tendon irritation (3.33%). Three cases that were treated by percutaneous pinning had complications; one case had pin-tract infection (3.33%), one case had loss of reduction and complex regional pain syndrome (3.33%), and one case had pin-tract granuloma (3.33%). Functional outcome was satisfactory in both groups. Conclusion Percutaneous pinning technique achieves comparable results with the ORIF by self-locked plating method in intra-articular distal radial fractures. Percutaneous pinning reduces operation time and soft-tissue dissection. Self-locked plating reduces collapse and loss of reduction rates.