Closed Reduction Percutaneous Pinning Research Articles

Cast versus Kirschner wire fixation in type II paediatric phalangeal neck fractures.

To compare the outcomes of type II pediatric phalangeal neck fractures (PPNFs) treated with closed reduction and cast immobilization (CRCI) versus closed reduction percutaneous pinning (CRPP), and evaluated the clinical efficacy of conservative versus surgical treatment of type II PPNFs via meta-analysis. Patients aged ≤ 14years with type II PPNFs were divided into conservative (CRCI) and operative (CRPP) groups. Radiographs measured angulation and translation; hand function was assessed with total active range of motion (TAM) and Quick-DASH. Complication rates were also compared between the groups. A meta-analysis of conservative versus operative treatment confirmed the clinical results. Statistical analysis was performed using SPSS 26.0 and R studio 3.0 with two-tailed, chi-squared, and Mann-Whitney U or t-tests, P < 0.05. Meta-analysis used fixed or random effects models, calculating mean differences and odds ratios for outcomes, and assessing heterogeneity with I2 and Q tests. Final angulation (3.4° ± 3.7° and 4.9° ± 5.4° vs. 3.6° ± 3.7° and 4.2° ± 4.3°) and displacement (6.3% ± 5.8% and 5.7% ± 4.7% vs. 5.8% ± 5.5% and 3.2% ± 4.2%) in the coronal and sagittal planes were not different statistically between the conservative and surgical groups (P > 0.05), but improved significantly compared to preoperative values (P < 0.05). Although Quick-DASH scores were comparable in both groups (P = 0.105), conservatively treated patients had a significantly better TAM at the last follow-up visit (P = 0.005). The complication rates were 24.2% and 41.7% in the surgical and conservatively treated groups respectively (P = 0.162). However, the latter primarily experienced imaging-related complications, whereas the former experienced functional complications (P = 0.046). Our meta-analysis (n = 181 patients) also showed comparable functional (P = 0.49) and radiographic (P = 0.59) outcomes and complication rates (P = 0.21) between the surgical (94 patients) and conservative (87 patients) groups. Conservative and surgical treatments are both reliable and safe approaches for managing type II PPNF in children. However, conservatively treated patients generally experience similar radiographic outcomes, lower complication rates, and better functional outcomes than surgically treated ones.

Comparative analysis of surgical outcomes in children with type 3 and type 4 lateral physeal condylar humerus fractures in China: Closed Reduction-PerCutaneous Pinning (CRPP) vs. Open Reduction-Internal Fixation (ORIF)

BackgroundLateral physeal condylar humerus fractures in pediatric patients aged 1–13 rank as the second most common elbow injury, occurring with a frequency ranging from 5% to 16.8%. There exists an ongoing debate regarding the surgical management of these fractures. This study aims to evaluate the efficacy of Open Reduction and Internal Fixation (ORIF) and Closed Reduction and Percutaneous Pinning (CRPP) as suitable surgical treatments for displaced unstable fractures of the lateral condyle physeal humerus in children. The comparison encompasses the results of ORIF and CRPP, alongside clinical and radiographic outcomes and complication rates. MethodA retrospective review was conducted at the Department of Orthopedic Surgery in the research hospital. A cohort of 27 patients treated between 2016 and 2023 were analyzed, 19 patients meeting inclusion criteria. The fracture pattern and degree of displacement were assessed, with specialized radiologists, doctors, and surgeons in agreement. Among the patients, 11 underwent CRPP 7 type 3and 4 type 2, while 16 received ORIF 12 type 4 and 4 type 5. Data collection included fracture type, surgical method, operation time, pre and post-operative displacement, casting period, bone union condition, follow-up records, range of motion, complications, delayed union, lateral spurring, and pin removal records. ResultsFor CRPP, the mean time for pin removal was 5.42 weeks, with excellent bone union and an average operation time of 34.57 min. Criteria of Hardacre showed 28.57% of cases as good and 71.42% as excellent. Similarly, ORIF demonstrated a mean operation time of 42.5 min, with the fracture healing within 5.33 weeks and the pin being removed after 15 days on average. Criteria of Hardacre indicated 25% of cases as good and 75% as excellent. Both groups showed satisfactory outcomes, with no complications such as osteomyelitis, nonunion, malunion, delayed union, myositis ossificans, physeal growth arrest, tardy ulnar nerve palsy, cubitus valgus, or varus, and no cases requiring re-surgery. ConclusionBoth CRPP and ORIF are effective surgical methods for treating lateral physeal condylar humeral fractures (types 3 and 4 according to the Song classification) in children, demonstrating satisfactory outcomes. Notably, regardless of displacement (2 mm and >2 mm), both methods yield similar results, albeit with CRPP offering the advantage of avoiding incisions. Overall, both procedures are safe, with favorable bone healing outcomes.

Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures.

Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes.

Closed Reduction Percutaneous Pinning Versus Open Reduction With Plate and Screw Fixation in Management of Unstable Proximal Phalangeal Fractures: A Systematic Review and Meta-analysis.

Proximal phalanx fractures are common, with surgical fixation indicated for unstable fractures. Traditionally, closed reduction percutaneous pinning (CRPP) resulted in decreased stiffness and tendon irritation compared to open reduction internal fixation (ORIF). We hypothesized that more recent studies would have more similar outcomes to CRPP. The purpose of this study was to compare CRPP and ORIF in terms of range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and complications. Four electronic databases were queried from 2010 to present. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent reviewers performed a two-step review process to identify relevant articles. Patient demographics, total active motion (TAM), DASH, and complications were extracted. The methodological quality of each study included was assessed independently. Meta-analysis was performed for comparative trials. Fourteen studies met inclusion criteria including four comparative studies: Thirteen studies included TAM. The weighted average TAM was 228 ± 34° for CRPP and 223 ± 32° for ORIF (P = .07 with 95% confidence interval (CI), -0.5 to 10.5). Seven studies evaluated DASH scores; weighted average was 8.2 ± 8.9 for CRPP and 11.7 ± 6.5 for ORIF (P < .01 with 95% CI, 1.8-5.2). Two studies directly compared CRPP to ORIF, favoring ORIF for both TAM with d = 1.07 and DASH with d = 0.23. Rates of tenolysis or hardware removal were higher for ORIF (P < .01). New literature suggests more equipoise with regard to treatment of proximal phalanx fracture with CRPP versus ORIF. Meta-analysis, Level II.

A meta-analysis of closed reduction percutaneous pinning and open reduction with pin fixation of pediatric humeral lateral condylar fracture.

To compare the effectiveness and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation to treat the pediatric humeral lateral condylar fracture. Studies comparing closed reduction percutaneous pinning vs. open reduction with pin fixation for treating pediatric lateral humeral condyle fractures were found by searching Pubmed, Embase, the Cochrane Library, and Web of Science databases, including randomized/non-randomized controlled, retrospective case-control, and prospective cohort studies. Furthermore, quality evaluation and data retrieval were conducted after the literature review. A meta-analysis was performed using RevMan 5.4 software to compare both groups' outcome measures. This Meta-analysis incorporated eight studies with 856 cases. The Meta-analysis found no significant difference in functional outcomes, superficial infection, deep infection, poor fracture union, avascular necrosis of the humeral capitulum, or lateral spur formation between groups. However, the status of unaesthetic scars in the closed reduction percutaneous pinning group was superior. For pediatric humeral lateral condylar fracture surgical therapy, the efficacy and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation were not significantly different; closed reduction percutaneous pinning offered the benefit of eliminating unaesthetic scar. However, further high-quality research is required to verify the conclusions of this Meta-analysis. https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023392451.

DISPLACED SUPRACONDYLAR HUMERUS FRACTURES REDUCED WITH CLOSED REDUCTION AND PERCUTANEOUS PINNING USING THE ARM BOARD TECHNIQUE IN CHILDREN.

Introduction: Closed reduction percutaneous pinning is the current gold standard of treatment for displaced supracondylar fractures of the humerus in children (CRPP). A simple CRPP process using a radiolucent arm board and simpler C-arm handling is described in this methodology. This method yields reproducible results and is easy to copy. It may also be used to any standard operating table.

THE OUTCOME OF IRREDUCIBLE PULSELESS SUPRACONDYLAR FRACTURE OF HUMERUS TREATED VIA ANTERIOR APPROACH – A CASE SERIES

Background: Treatment of a pulseless pediatric supracondylar humeral fracture is controversial and varies from closed reduction percutaneous pinning to Surgical Exploration. Present study aimed to analyze outcome of Irreducible pulseless supracondylar fractures treated with Open reduction and exploration via anterior approach. in this prospective study of 7 patients Method: with pulseless Supracondylar fracture, 2 were treated by Close reduction percutaneous pinning and the other 5, irreducible on table by Open intervention. The later 5 cases were followed up at 3 weeks, 6 weeks, and 3 months and functionally assessed using MEPS. 3 cases Results: showed immediate return of pulse, 2 recovered within 6 hours. All cases at 3 months showed MEPS &gt;90. Anterior approach is excellent Conclusion: for surgical decompression of the neurovascular bundle.

Operative Fractures of the Phalangeal Head and Neck in Children-Does Open Reduction Affect Outcomes?

Closed reduction percutaneous pinning of displaced pediatric phalangeal head and neck fractures is preferred to prevent malunion and loss of motion and function. However, open reduction is required for irreducible fractures and open injuries. We hypothesize that osteonecrosis is more common in open injuries than closed injuries that require either open reduction or closed reduction percutaneous pinning. Retrospective chart review of 165 phalangeal head and neck fractures treated surgically with pin fixation at a single tertiary pediatric trauma center from 2007 to 2017. Fractures were stratified as open injuries (OI), closed injuries undergoing open reduction (COR), or closed injuries treated with closed reduction (CCR). The groups were compared using Pearson χ 2 tests and ANOVA. Two group comparisons were made with Student t test. There were 17 OI fractures, 14 COR fractures, and 136 CCR fractures. Crush injury was the predominant mechanism in OI versus COR and CCR groups. The average time from injury to surgery was 1.6 days for OI, 20.4 days for COR, and 10.4 days for CCR. The average follow-up was 86.5 days (range, 0 to 1204). The osteonecrosis rate differed between the OI versus COR and OI versus CCR groups (71% for OI, 7.1% for COR, and 1.5% for CCR). Rates of coronal malangulation >15 degrees differed between the OI and COR or CCR groups, but the 2 closed groups did not differ. Outcomes were defined using Al-Qattan's system; CCR had the most excellent and fewest poor outcomes. One OI patient underwent partial finger amputation. One CCR patient had rotational malunion but declined derotational osteotomy. Open phalangeal head and neck fractures have more concomitant digital injuries and postoperative complications compared with injuries closed on presentation, regardless of whether the fracture underwent open or closed reduction. Although osteonecrosis occurred in all 3 cohorts, it was most frequent in open injuries. This study allows surgeons to discuss rates of osteonecrosis and resultant complications with families whose child presents with phalangeal head and neck fractures that are indicated for surgical treatment. Therapeutic, Level III.

Does open reduction internal fixation using a volar locking plate and closed reduction percutaneous pinning using K wires provide similar functional and radiological outcomes for unstable distal radius fractures?

Background: Distal radius fractures (DRFs) are a common orthopedic injury, with open reduction internal fixation (ORIF) and closed reduction percutaneous pinning (CRPP) being the two most frequently used methods for treating unstable DRFs. The optimal treatment approach for DRFs is still a matter of debate. Therefore, this retrospective analysis aimed to compare the functional and radiological outcomes of ORIF and CRPP to determine the most effective approach for treating unstable DRFs. Material and Methods: A total of 89 patients were included in this retrospective study; 34 underwent CRPP and 55 underwent ORIF (61 males and 28 females, mean age: 35.5). Radiographic measurements of radial inclination, radial height, and volar tilt, as well as patient-rated wrist evaluation (PRWE) scores for pain and function, were used to evaluate the functional and radiological outcomes during the final follow-up period, ranging from 1 to 4 years. Results: There were significant improvements in the radiographic measurements for both groups, indicating a good reduction. However, the two fixation methods had no significant difference in radiographic measurements during the entire follow-up period. Regarding PRWE scores, there was a significant difference between the two groups, with patients in the CRPP group reporting better wrist function and less pain. Conclusions: Both CRPP and ORIF are effective methods for treating unstable DRFs. Achieving an acceptable reduction did not correlate with better pain management, function, or the ability to carry out day-to-day activities. However, patients treated with CRPP had better wrist function and less pain during follow-up. Radiographic measurements did not differ significantly between the two groups. Clinicians should consider closed-reduction percutaneous pinning as a viable and effective treatment option for distal radius fractures, particularly when optimal wrist function and pain management are important considerations.

Does posterior approach always lead to poor functional and cosmetic outcomes in displaced pediatric supracondylar humeral fractures?

Supracondylar humerus fractures (SCHFs) are the most common types of elbow fractures in children. Closed reduction percutaneous pinning (CRPP) is the primary surgical treatment of SCHFs. In cases that cannot be managed with closed reduction, treatment with open reduction and internal fixation (ORIF) is necessary. We aimed to compare CRPP and ORIF through a posterior approach regarding clinical and functional outcomes in pediatric SCHF cases. Patients with Gartland type III SCHF who underwent CRPP or ORIF with posterior approach at our clinic between January 2013 and December 2016 were included in this retrospective study. A total of 60 patients who underwent surgical treatment and had available data on our hospital database and no additional injuries were included in the study. We analyzed their data concerning age, gender, fracture type, neurovascular damage, and surgical treatment. In addition, we inspected the patients' anteroposterior and lateral radiographs at 1-year follow-up visits for Baumann (humerocapitellar) angle (BA) and carrying angle (CA) and checked their go-niometer assessments of elbow range of motion (ROM). The cosmetic and functional outcomes were determined using Flynn's criteria. Demographic, preoperative, and post-operative data of 60 patients between the ages of 2-15 were analyzed. 46 of these patients had CRPP, and 14 had posterior ORIF. CA, Baumann angle, and lateral capitello-humeral angle were measured for fractured elbow and contralateral elbow and compared statistically. There was no statistically significant difference between the two surgical ap-proaches in terms of CA (p=0.288), Baumann's angle (p=0.951) and LHCA (p=0.578). At the end of 1-year follow-up, elbow ROM was measured, and there was no statistically significant difference between the two groups (p=0.190). Furthermore, there is no statistically significant difference between the two surgical approaches in terms of both cosmetic (p=0.814) and functional (p=0.319) outcomes. A comprehensive literature review of pediatric SCHF shows that surgeons do not frequently prefer posterior incisions in Gartland type III fracture that cannot be managed with closed reduction. However, posterior open reduction is a safe and effective method since it provides more control over the distal humerus, allows for a complete anatomical reduction involving both cortices, reduces the risk of ulnar nerve injury, thanks to the nerve exploration, and yields positive cosmetic and functional outcomes.

Functional Outcome of Displaced Intra-articular Fractures of the Distal Radius: Comparison of Closed Reduction Percutaneous Pinning with or without External Fixation versus Open Reduction Plate Fixation

Objectives. The purpose of the study was to determine the outcomes of closed reduction percutaneous pinning (CRPP) with or without external fixation (EF) with open reduction and internal fixation (ORIF) using plate and screws. Methods. Outcomes of ORIF versus CRPP, with or without external fixation for intra-articular distal radius fractures were compared through a multicenter, non-randomized, ambispective cohort study. A validated Filipino version of the DASH score (FIL-DASH) was used as primary outcome measure.Results. The ORIF group consisted of 13 patients and the CRPP group, eight patients. Pain scores, post-operative complications and radiographic measurements were also evaluated. Mean FIL-DASH score for the ORIF group (M=26.69, SD=4.88) was significantly higher versus the CRPP group (M=14.59, SD=10.64; t(19)=3.58, p=0.002). No significant differences in radiologic parameters, pain scores, and complications were found.Conclusion. The study demonstrates that functional outcomes post-CRPP with or without external fixation compares favorably over ORIF for distal radius fractures at one-year post-surgery.

Socioeconomic status does not change decision-making in the treatment of distal radius fractures at a level 1 trauma center.

To compare operative rates, total hospital charges, and length of stay between different socioeconomic cohorts in treating distal radius fractures (DRFs). A retrospective cohort study. Large public level 1 trauma center. A retrospective search of all trauma activations over a 7-year period (2013-2020) yielded 816 adult patients diagnosed with DRF. Patients were separated into cohorts of socioeconomic status based on 2010 US Census data and insurance status. DRFs were treated either nonoperatively using closed reduction and splinting or operatively using open reduction and internal fixation, closed reduction percutaneous pinning, or external fixator application. Operative rates of DRF, total hospital charges, and length of stay. Patients who were uninsured or in the low-income socioeconomic cohort had no significant difference in operative rates, total hospital costs, or length of stay when compared with their respective insured or standard income groups. Younger patients and those with OTA/AO type C, bilateral, or open DRFs were more likely to undergo operative intervention. This study demonstrates that low socioeconomic status based on annual household income and insurance status was not associated with differences in operative rates on DRFs, length of stay, or total hospital charges. These results suggest that outcome disparities between groups may be caused by postoperative differences rather than treatment decision-making. Although this study investigates access to surgical care at a publicly funded level 1 trauma center, disparities may still exist in other models of care. Prognostic Level III.

COMPARATIVE ANALYSIS AND FUNCTIONAL OUTCOME OF EXTRAARTICULAR DISTAL RADIUS FRACTURES TREATED WITH CLOSED REDUCTION AND PERCUTANEOUS PARALLEL VERSUS CROSS PINNING

Introduction: Different treatment modalities can use to reduce and stabilize distal end radius articular fractures like Closed reduction, Percutaneous pinning, Ligamentotaxis, Open reduction and internal xation. In the absence of adequate xation, fractures tend to displace to their prereduction position, resulting in pain, malunion, restricted range of motion, and post traumatic arthritis, weakness at wrist joint and/ or Sudeck's Osteodystrophy. A total of 30 patients with extraarticular distal radius frac Material And Methods: tures were enrolled in the study. All distal radius fractures treated with closed reduction percutaneous pinning parallel or crossed, post operatively evaluated for radiological outcome by radiographs and functional outcome by Gartland &amp; Werley score. Radiological score w Results: as done using Sarmiento's modication of Lindstrom criteria. In crossed k wire group 73% of patients obtained excellent outcome, 20% patient showed goof outcome and 7% patients showed fair outcome. In parallel k wire group 53% of patients showed excellent results while 27% and 20% obtained good and fair outcomes respectively. Functional outcome evaluated using Gartland and Werley scoring system. In crossed k wire group 60% of patients obtained excellent outcome, 20% patient showed good outcome and 20% patients showed fair outcome. In parallel k wire group 60% of patients showed excellent results while 13% and 20% obtained good and fair outcomes respectively and 7% showed poor outcome. K wire xation can be used Conclusion:- as a primary modality of treatment of distal radius fractures with clear advantage of reduced time required for imaging and early commencement of physiotherapy for better functional outcome. Our study concludes both groups were comparable in terms of radiological and functional out comes but subjective evaluation was slightly better in crossed pinning group with statistically no signicant difference. Hence, both the modalities can be used as a good alternative to open surgery depending up on the fracture type, patients' health status and surgeons' choice.

Comparison between closed reduction plaster casting and percutaneous Kirschner wire pinning in the management of distal radius fractures in patients aged 65 years and older

Aim: Closed reduction plaster casting (CRPC) and percutaneous pinning (CRPP) remain an important treatment modalities for extra-articular distal radius fractures especially in elderly patients. These two treatment methods have advantages and disadvantages compared to each other. The ideal treatment of extra-articular distal radius fractures is still debatable. We aimed to retrospectively evaluate the clinical and radiological results after CRPC and CRPP for the treatment of distal radius fractures in the patient population over 65 years of age.&#x0D; Material and Method: Between 1 January 2015 and 1 January 2019, patients older than 65 years of age who presented with extra-articular noncomminuted distal radius fractures were retrospectively evaluated. 95 patients diagnosed with distal radius fracture were separated into 2 groups, who were administered the following: CRPC (n:51), CRPP (n:44). We compared the characteristics of the patients, the mechanisms of injury, fracture types and treatment methods, pre-reduction and post-reduction radiological parameters and clinical functions for the two groups. Volar tilt, radial inclination, ulnar variance, and radial length were compared. Clinical results were also compared.&#x0D; Results: The mean follow-up period was 19.8 months (range, 12-29 months; SD=11.0) in the CRPC group and 18.6 months (range, 12-26 months; SD=10.9) in the CRPP group. Mean range of motion and grip strength were maintained in both treatment groups at one-year follow-up. There was no statistically significant difference between the groups (p&gt;0.05). There was no statistically significant difference between the groups in terms of the scores evaluating the daily activity, pain and mental status of the patients after the treatment (p&gt;0.05). There are no statistically significant differences between fixation with CRPC and CRPP in terms of clinical and radiological results (p&gt;0.05). &#x0D; Conclusion: Closed reduction plaster casting and closed reduction percutaneous pinning are equally effective in the treatment of extra-articular distal radius fractures in the elderly.

A Biomechanical Comparison of Fixation Techniques in Metacarpal Shaft Fractures.

Background Typically, metacarpal shaft fractures are treated with closed reduction percutaneous pinning, intramedullary nails, or plate fixation. Recently some surgeons have begun using intramedullary headless compression screws. Questions/Purposes The purpose of this study was to compare intramedullary screw fixation to K-wire fixation, which is the standard of care in a transverse metacarpal midshaft fracture, using a cadaveric model. Our hypothesis was that intramedullary screw fixation would have a biomechanical advantage (higher stiffness and peak load to failure) when compared with dual Kirschner wire fixation of transverse metacarpal shaft fractures. Methods Four-point bend testing was performed to compare stiffness and failure load values of seven paired 2nd and 3rd metacarpals instrumented with headless intramedullary compression screw fixation or Kirschner wire fixation. Similar testing was performed on 14 unpaired 4th metacarpals. Results There was no significant difference in peak load ( p = 0.60) or stiffness ( p = 0.85) between fixation groups for the 2nd and 3rd instrumented metacarpals. For the instrumented 4th metacarpals, there was no significant difference in peak load ( p = 0.14), but the stiffness was significantly greater ( p = 0.01) for the compression screw group compared with the Kirschner wire fixation. Conclusions/Clinical Relevance In this study, the load to failure was not different between the two fixation methods and likely both techniques can sustain physiologic loads needed for rehabilitation. The greater stiffness in the 4th metacarpal compression screw group may be related to the smaller canal morphology than in the 2nd and 3rd metacarpals. Larger diameter screws may be needed to obtain a better fit particularly in the 2nd and 3rd metacarpals.

Trends in Distal Radius Fixation Reimbursement, Charge, and Utilization in the Medicare Population

Background Distal radius fractures (DRF) are the second most common fragility fracture experienced by the elderly, and surgical management constitutes an appreciable sum of Medicare expenditure for upper extremity surgery. Using Medicare data from 2012 to 2017, our primary aim was to describe temporal changes in surgical treatment, physician payment, and patient charges for DRF fixation.Methods We examined surgical volumes and retrospective patient charge (services billed by surgeon) and surgeon payment (professional fee) data from 2012 to 2017 for four DRF surgeries: closed reduction percutaneous pinning (CRPP), open reduction internal fixation (ORIF) of extra-articular fractures, ORIF of intra-articular (IA) (2-fragment) fractures, and ORIF of IA (> 3 fragments) fractures. The reimbursement ratio was defined and calculated as the ratio of charges to payment. Rates were adjusted for inflation using the annual consumer-price index.Results For these four surgeries from 2012 to 2017, total patient charges grew by 64% from $117 to 193 million, while surgeon payment grew by 42% from $30 to 42 million. CRPP cases fell by 47%, while ORIF increased by 17, 14, and 45% for extra-articular, IA (2-fragment), and IA (> 3 fragments) surgeries, respectively. After adjusting for inflation, payment to physicians increased by more than or equal to 16% for all procedures except for CRPP, which fell by 2%. Charges during this same period increased from 13 to 38%. Reimbursement ratios declined from −9.2% to −13% for each procedure.Conclusion From 2012 to 2017, while charges have outpaced surgeon payment, payment has outpaced inflation for all forms of distal radius ORIF, aside from CRPP. There has been a continued sharp decline of CRPP. Level of Evidence is III, economic.

Unicolumnar Pin Fixation of Type III Supracondylar Humeral Fractures Is Associated With Over 3 Times Higher Odds of Lost Reduction.

To compare the rate of lost reduction between 2 groups of non-age-segregated type III supracondylar humeral fracture patients: a unicolumnar versus bicolumnar fixation group. Retrospective cohort study. Pediatric Academic Trauma Center. We identified 257 patients with type III supracondylar humerus fractures from surgical billing records over a 5-year period. There were 183 patients identified with bicolumnar fixation (71.2%) and 74 patients identified with unicolumnar fixation (28.8%). Closed reduction percutaneous pinning of the distal humerus. The primary outcome measure was difference in rate of lost reduction between patients with bicolumnar (lateral and medial column) and unicolumnar (lateral column only) fixation (Fig. 1). The reduction and fixation at the time of fluoroscopy was assessed using the Baumann angle, Gordon index, and anterior humeral line. Loss of reduction was assessed at time of healing, defined by a Baumann angle change ≥10 degrees and Gordon index of ≥50% (Fig. 2). There were 183 patients with bicolumnar fixation and 74 patients with unicolumnar fixation included in the study (average age 5.8 years; range, 2-14 years). The rate of lost reduction in patients with bicolumnar fixation was 6.01% (11/183), whereas 17.57% (13/74) of patients with unicolumnar fixation experienced lost reduction. These rates were significantly different (P = 0.008) with a 3.3 times higher odds (95% confidence interval = 1.3-8.6) of lost reduction with unicolumnar fixation. There is a statistically significant increase in the rate of supracondylar fracture loss of reduction for patients with unicolumnar fixation when compared with bicolumnar fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Trending a decade of proximal humerus fracture management in older adults.

BackgroundProximal humerus fractures are the third most common fracture in older adults. Because of the aging population, the incidence of these fractures and their impact will continue to grow. With advancement in treatment options for proximal humeral fractures, the aim of this study was to evaluate the trends in acute management of proximal humerus fractures to determine how definitive treatment has changed over the past decade in patients older than 65 years.MethodsUsing a commercially available database, patient records were queried from 2010 to 2019 for the incidence of proximal humerus fractures. For each individual year, data were queried to identify the incidence of closed reduction percutaneous pinning (CRPP), hemiarthroplasty (HA), intramedullary nailing (IMN), open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), or nonoperative treatment for acute proximal humeral fractures. A Cochran-Armitage trend test was used to determine significant changes in the trends of proximal humerus fracture management. Logistic regression analyses were performed to generate odds ratios (OR) with associated 95% confidence intervals comparing each individual procedure performed in 2019 to 2010.ResultsA total of 160,836 patients at least 65 years of age and older were diagnosed with a proximal humerus fracture. Of this total, 28,503 (17.72%) patients received operative treatment and 132,333 (82.28%) received nonoperative treatment. From 2010 to 2019, operative treatment trends of proximal humerus fractures changed such that CRPP decreased by 60.0%, HA decreased by 81.4%, IMN decreased by 81.9%, ORIF decreased by 25.7%, TSA decreased by 80.5%, and RSA increased by 1841.4% (all P < .0001). Overall, nonsurgical management increased from 80% to 85% during the examined study period (P < .0001). Patients in 2019 were significantly more likely to receive an RSA (OR 22.65) and were significantly less likely to receive CRPP (OR 0.45), HA (OR 0.20), IMN (OR 0.20), ORIF (OR 0.82), and TSA (OR 0.22) than patients in 2010. In addition, patients in 2019 were significantly more likely to receive nonoperative treatment than patients in 2010 (OR 1.10).ConclusionOver the past decade, most of older adults who sustain proximal humerus fractures continue to receive nonoperative treatment. Although CRPP, IMN, HA, ORIF, and TSA have decreased, RSA has recently become more widely utilized, which is consistent with what has been noted in other countries. Continued examination of the mid- and long-term outcomes of the increasing percentages in RSA should be performed in this population.

Comparative Analysis of Open Reduction Internal Fixation and Closed Reduction Percutaneous Pinning of Hand Fractures: Single Academic Center Retrospective Review.

The purpose of our study was to compare postoperative outcomes between patients receiving closed reduction percutaneous pinning (CRPP) to open reduction internal fixation (ORIF) following metacarpal and phalanx fractures. A retrospective chart review was performed at a single academic center for all patients suffering a metacarpal or phalanx fracture and receiving either CRPP or ORIF between 2012 and 2018. Patients were divided into fracture mechanism, high-energy mechanism of injury, low-energy mechanism of injury, or unknown, and treatment of fracture with either ORIF or CRPP. High-energy mechanism of injury included gunshot wounds, motor vehicle crash, and blast injuries, whereas low-energy mechanism of injury included all other causes. Patient demographics, postoperative complications, 30-day readmission, and return to the operating room were recorded. A total of 408 patients, with 524 fractures, were included in the study. There were 127 fractures that resulted from high-energy mechanisms and 394 fractures that resulted from low-energy mechanisms. Open reduction internal fixation was used to treat 299 fractures, whereas CRPP was used for 225 fractures. Among fracture fixation, there was a total of 8.4% complication rate with ORIF, accounting for 10.4% of complications, and CRPP accounting for 5.8%. Among the fracture mechanism, the high-energy mechanism of injury had a 21.3% complication rate, whereas the low-energy mechanism of energy was 4.3%. When comparing the above variables, only high-energy mechanism of injury was a statistically significant predictor of complications (odds ratio, 3.2; confidence interval, 1.5-7.0; P = 0.002). The average operating room time for the ORIF group was 124.82 minutes compared with 97.6 minutes for the CRPP group. Patients with hand fractures corrected by ORIF appeared to have a higher postoperative complication rate. When the 2 procedures, ORIF and CRPP, were controlled for mechanism of injury, there was not a statistically significant difference in postoperative complication rate (P = 0.14). However, a fracture sustained by a high-energy mechanism was a statistically significant predictor of postoperative complications (P = 0.002).

Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws.

Long oblique extra-articular proximal phalanx fractures are common orthopedic injuries. When unstable and without substantial comminution, treatment options include closed-reduction percutaneous pinning (CRPP) and open-reduction internal fixation using lag screws (ORIF-screws). The aims of this study are primarily to compare the functional outcomes and complication rates between these techniques and secondarily to assess potential factors affecting outcomes after surgery. All patients with long oblique extra-articular proximal phalanx fractures treated surgically within a single orthopedic institution from 2010 to 2017 were identified. Outcome measures and complications were assessed at the final follow-up. Sixty patients were included in the study with a mean time to the final follow-up of 41 weeks (range: 12-164 weeks). Thirty-four patients (57%) were treated with CRPP and 26 patients (43%) with ORIF-screws. The mean Disabilities of the Arm, Shoulder, and Hand score across both fixation types was 8 (range: 0-43) and did not differ significantly between the 2 groups. Mean proximal interphalangeal extension at the final follow-up was 9° short of full extension after CRPP and 13° short of full extension after ORIF-screws. The rates of flexion contracture and extensor lag were 15% and 41% in the CRPP group compared with 12% and 68% in the ORIF-screws group. Reoperation rates and complication rates did not differ significantly between fixation strategies. Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both CRPP and ORIF-screws. Extensor lag may be more common after ORIF-screws.