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We thank Drs. van Aaken, Beaulieu, and Fusetti for their comments. It is the case that our results differ from those reported by these investigators in their May 2008 article in Chirurgie de la Main,1van Aaken J. Beaulieu J.Y. Della Santa D. Kibbel O. Fusetti C. High rate of complications associated with extrafocal kirschner wire pinning for distal radius fractures.Chir Main. 2008; 27: 160-166Crossref PubMed Scopus (17) Google Scholar which included a complication rate of 44% and recurrent dorsal angulation in 79%. They described the technique that they used as consistent with the recommendations of DePalma2DePalma A.F. Comminuted fractures of the distal end of the radius treated by ulnar pinning.J Bone Joint Surg. 1952; 34A: 651-662Google Scholar and Willeneger and Guggenbuhl,3Willenegger H. Guggenbuhl A. Operative treatment of certain cases of distal radius fracture.Helv Chir Acta. 1959; 26: 81-94PubMed Google Scholar which is to place pins across the fracture from the radial styloid to the ulnar cortex of the distal radius. Our strong suspicion is that the discrepancy between our results and theirs is a consequence of the technique used for pin fixation. It has been shown in biomechanical studies by Adams4Rogge R.D. Adams B.D. Goel V.K. An analysis of bone stresses and fixation stability using a finite element model of simulated distal radius fractures.J Hand Surg. 2002; 27: 86-92Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar and Naidu5Naidu S.H. Capo J.T. Moulton M. Ciccone II, W. Radin A. Percutaneous pinning of distal radius fractures: a biomechanical study.J Hand Surg. 1997; 22: 252-257Abstract Full Text PDF PubMed Scopus (56) Google Scholar that orthogonal placement of pins is the most stable construct, and that has certainly been our impression clinically. We place 2 pins in the radial styloid and 1 or 2 pins perpendicular to those from the dorsal rim of the distal radius into the volar cortex. We avoid some of the pin problems cited by the respondents, including radial nerve injury or irritation, by placing the pins under direct vision through a 1–2 cm incision over the radial styloid and using a tissue protector to avoid the nerve and tendons of the first extensor compartment. Contrary to the suggestion in the letter to the editor, we do not “uniformly” recommend pinning for treatment of distal radius fractures. As indicated in our paper, the technique is appropriate for 2- and 3-part fractures of the distal radial metaphysis, including AO types A2, A3, C1, and C2. Severe comminution is a contraindication. In response to their other specific points, the number of patients in each specific AO category was 25 A2 fractures, 15 A3 fractures, 9 C1 fractures, and 6 C2 fractures. There was no statistical correlation between age and outcome using the parameters of range of motion, grip strength, and Disabilities of the Arm, Shoulder, and Hand score. The AO classification of patients who lost dorsal tilt was 4 A2 fractures, 2 A3 fractures, and 2 C2 fractures. The AO classification of patients who lost radial length was 4 A2 fractures, 1 A3 fracture, and 1 C2 fracture. Loss of radial inclination occurred in 1 A2 fracture, 1 A3 fracture, and 1 C2 fracture. An articular stepoff of less than 2 mm occurred in 1 A2 fracture, 1 A3 fracture, and 1 C2 fracture. Pain was not associated with loss of reduction, which might well have been due to the fact that the loss of reduction was mild in the few patients in whom it occurred. No patient had more than a 2-mm stepoff, and none had painful degenerative changes. Long-Term Outcomes of Closed Reduction and Percutaneous Pinning for the Treatment of Distal Radius FracturesJournal of Hand SurgeryVol. 34Issue 5PreviewWith interest, we read the article by Glickel et al.1 The excellent results cited are in strong contrast to the finding in our series2 and those of other studies.3,4 For a better understanding, it would be important to know the indication for the surgery, the preoperative radiographic values, and the number of patients in each AO subgroup, as well as the relation between age, fracture type, and outcome. It would be useful to know the fracture pattern of the patients who lost reduction, whether pain was associated with the loss of reduction, and whether patients with an articular step developed any (painful) degenerative arthritic changes. Full-Text PDF