Kapandji Pinning Research Articles

The Kapandji pinning: Technique of closed reduction for distal end radius fracture in adults

The Kapandji pinning: Technique of closed reduction for distal end radius fracture in adults

Outcomes Following Temporary Kapandji Pinning Technique and Distal Radial LCP Fixation for Intra-Articular Fractures of the Displaced Distal Radius.

In partially or completely displaced intra-articular fracture of the distal radius , achieving satisfactory reduction and maintenance of good reduction before applying the plate may be difficult. Especially to accomplish the anatomic volar tilt remains a problem. Typically, the Kapandji technique has been described to reduce and stabilize a large displaced and extra-articular fracture of the distal radius. We present the results of a prospective series using the temporary Kapandji technique for K-wire intrafocal fixation followed by rigid fixation with distal radial locking compression plate. The mean follow-up period totaled 12 months. A total of 57 patients were evaluated by radiographic and clinical review. The modified Mayo wrist score was used for postoperative patient evaluation. The clinical results on follow-up were good to excellent. Minimal joint stiffness and functional outcomes of the wrist and elbow were satisfactory. Statically significant differences were found between the preoperative and postoperative radiologic parameters. No skin infection due to K-wire insertion was noted, and the fracture healed completely in every case. This paper reports the results of 57 cases of intra-articular fractures of the distal radius treated by Kapandji wires as a reduction tool and definitive fixation by the application of a locked volar plate. It could be performed easily and reliably. K-wires were used to temporarily maintain reduction throughout the rigid fixation without further displacement in the follow-up clinic. The results proved appropriate, and the technique has merit, as it obviates the need for dorsal exposure in most cases.

Treatment of paediatric unstable displaced distal radius fractures using Kapandji technique: a case series.

The technique of intra-focal pinning described by Kapandji is seldom used in paediatric patients. We present our series of paediatric patients treated with Kapandji technique for unstable displaced distal radius fractures. We retrospectively reviewed medical records and radiographs of a consecutive series of 56 paediatric patients who underwent closed reduction and fixation with Kapandji technique for unstable displaced metaphyseal and Salter Harris 2 distal radius fractures, from 2008 to March 2018. One or two percutaneous K-wires were inserted intra-focally without crossing the physis to lever out, reduce and stabilize the distal fragment. The arm was immobilized withan above-elbow cast, and radiographic controls were scheduled at 1, 4, 8weeks, at least. The mean age at the time of the trauma was 10.5years. The K-wires were removed at a mean of 6.4 post-operative weeks. An above-elbow cast was used for the first 4weeks, afterwards a below-elbow cast for 2weeks and a short-arm brace until the full recovery of motion. The mean follow-up was 18months (range 1.5-108months). No pin-related complications were found. All fractures showed good healing, and the full function of the wrist was achieved in every case. Kapandji pinning is a reliable technique in paediatric patients with unstable displaced distal radius fractures. It shows a lower complication rate compared to other techniques. For these reasons, we suggest implementing its use in clinical practice.

Kapandji pinning and tuberosities fixation of three- and four-part fractures of the proximal humerus

The Kapandji pinning was initially described for the treatment of surgical neck fractures of the humerus in young patients. The aim of our study was to evaluate functional and radiological outcomes of the Kapandji modified technique in displaced complex three- and four-part fractures. From 2005 to 2009, 32 patients (23 three-part and nine four-part fractures) were included retrospectively. The mean age was 63 years old (range, 22-86), and the dominant shoulder was involved in 40% of the cases. At a mean follow up of 25 months (12-72), the mean absolute Constant score achieved 68 points (35-98) and adjusted score 80% (47-100). Patients had an average forward elevation of the shoulder of 132° (80°-180°), an average external rotation of 36° (0°-90°), and an average internal rotation to the level of L1 (sacrum to the level of T6). The older the patients were the worst was the active anterior elevation recovery (r = -0.3; p = 0.01). Reduction and fixation of initial varus-displaced fractures was not as reliable as in valgus. In eight cases (25%), K-wire migrations were observed and were correlated with age over 70 years old (p = 0.001). Two partial osteolysis of the greater tuberosity and two avascular necrosis of the humeral head (one was associated with a non-union) were identified. Moreover, three patients developed adhesive capsulitis. The Kapandji technique with fixation of tuberosities provides satisfactory results for the treatment of complex proximal fractures of the humerus. However, we do not recommend this technique for patients older than 70 years and in cases of varus displaced fractures.

Bilan arthroscopique des fractures articulaires du radius distal ostéosynthésées par des techniques d’embrochage percutanée

Objectives We studied the radiological results of percutaneous pinning in articular fractures of the distal radius. We did not, thereby, have a method of direct ligamentous and articular assessment. We realized an anatomical arthroscopic assessment at six weeks of osteosynthesis of wrists. The purpose was to study the correlation between the presence of anatomical lesions and the functional result. Methods Thirty-five patients presenting an articular fracture with posterior displacement were included; 30 women and five men. The mean age was 62 years. All the patients were right -handed and this was the fractured side in 18 patients. The patients had clinical and radiological follow-up at three, six, 12 weeks and one year. Surgical techniques were Py or Kapandji pinning. An arthroscopy of the wrist was carried out at six weeks from the fixation at pin removal. An assessment of ligamentous lesions and quality of articular reduction was performed. Results Twenty-eight per cent of the patients had ligamentous lesions. Nine patients presented an interfragmentary distance greater than 1 mm. Two patients had an articular step as high as 2 mm. Conclusions Clinical examination did not show any correlation between the anatomical imperfections noted at the time of arthroscopy and the function of the wrist at one year postoperative, regardless of the technique used.

Ostéosynthèse antérieure par plaque à vis verrouillée LCP 3.5® dans les fractures de l’extrémité inférieure du radius à déplacement postérieur. À propos de 24 cas

Fracture of the distal radius with posterior displacement is the most common wrist fracture. Pinning is generally proposed. The problem is that a secondary displacement may persist, even for the least complex fractures. With the advent of the fixed-angle plate with a self-locking screw, we considered using this method in combination with an anterior approach to the radius. We report our preliminary results. From November 1 to March 31, 2003, among the 195 fractures of the distal radius with posterior displacement which we treated in our unit, 135 were treated with orthopedic reduction, 36 with Kapandji pinning and 24 with a T-shaped anterior locking compression plate (Synthès, LCP 3.5. During the early part of this series, the LCP was used for emergency situations in young adults with a posterior displacement exceeding 20 degrees . Starting in November 2002, the technique was also proposed for revisions for secondary displacements after orthopedic reduction or pinning procedures. Secondary displacement was noted on the standard X-rays and the clinical analysis included a measurement of muscle strength, the DASH score and the clinical evaluation score used by the SOFCOT symposium in November 2000. Twenty-four patients (14 female, 10 male, mean age: 54.5 years) presented 14 extra-articular fractures and ten articular fractures. At admission, mean frontal inclination of the radial glenoid was 13 degrees with a posterior displacement of 25.45 degrees and an ulnar variance measuring+4mm. Eighteen patients were reviewed at mean 16 months follow-up. Mean frontal inclination of the glenoid was 23.95 degrees with mean anteversion 5.45 degrees . Using the SOFCOT criteria, 11 outcomes were anatomic and seven presented moderate displaced healing. The wrist force (Jamar was 95% of the value measured on the healthy side. The mean DASH score was 38.47. Outcome was considered excellent for nine cases, good for six, fair for three and poor for zero. Complications were: reflex dystrophy (n=4), carpal tunnel syndrome (n=1), cheloid scar (n=1), glenoids in the pulse gutter (n=10), and secondary fracture along the upper border of the plate (n=3). This study demonstrated that, used on the anterior aspect of the radius, the locking compression plate provides satisfactory treatment for fractures of the distal radius with posterior displacement. Because of the angular stability, the reduction can be maintained over time so that secondary displacement is no longer a problem. This is a difficult technique which requires particular skill. We no longer recommend the LCP 3.5 plate due to the poorly adapted ergonometry, the late fracture over the plate and the fact that the material is not removed.

Percutaneous pinning for treating distal radial fractures in adults

Fracture of the distal radius is a common clinical problem. A key method of surgical fixation is percutaneous pinning, involving the insertion of wires through the skin to stabilise the fracture. To evaluate the evidence from randomised controlled trials for the use of percutaneous pinning for fractures of the distal radius in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2006), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, conference proceedings and reference lists of articles. No language restrictions were applied. Randomised or quasi-randomised controlled clinical trials involving adults with a fracture of the distal radius, which compared percutaneous pinning with conservative treatment, or different aspects of percutaneous pinning. Two authors independently assessed and extracted data from the included trials. Some pooling of data was undertaken for one comparison. Thirteen trials, involving 940 generally older adults with dorsally displaced and potentially or evidently unstable distal radial fractures, were included. Methodological weaknesses among these trials included lack of allocation concealment and inadequate outcome assessment. Factors affecting the applicability of trial evidence included inconsistent fracture classification, variations in outcome assessment and incomplete reporting. Six heterogeneous trials compared percutaneous pinning with plaster cast immobilisation. Across-fracture pinning, used in five trials, was associated with improved anatomical outcome and generally minor complications. There was some indication of similar or improved function in the pinning group. One quasi-randomised trial found an excess of complications after Kapandji pinning. Three trials compared different methods of pinning. Two trials found a higher incidence of complications after Kapandji fixation compared with two methods of across-fracture fixation. The third trial provided inadequate evidence for modified Kapandji fixation versus Willenegger fixation. Two small trials comparing biodegradable pins versus metal pins found a significant excess of complications associated with biodegradable material. Two small trials compared plaster cast immobilisation for one week versus for six weeks after surgery. One trial found duration of immobilisation after trans-styloid fixation did not have a significant effect on outcome. More complications occurred in the early mobilisation group after Kapandji pinning in the second trial. Though there is some evidence to support its use, the precise role and methods of percutaneous pinning are not established. The higher rates of complications with Kapandji pinning and biodegradable materials casts some doubt on their general use.

Distal radial fractures

There is some evidence to suggest superior results of surgical treatment that includes open reduction internal fixation (ORIF) or percutaneous pin fixation (not including Kapandji pinning) to stabilize fracture fragments and improve functional ability compared with conservative treatment. However, larger studies with longer follow-up are needed to verify these results.

Ambulante KD-Stiftung distaler Radiusfrakturen: Outcome-Beurteilung im Vergleich verschiedener Scoring-Systeme

Fractures of the distal radius represent one of the most common fractures and have a high social-economic relevance. For A2- and A3-fractures as well as for some cases of displaced intraarticular C-fractures we prefer closed reduction and K-wire fixation. We retrospectively analysed our results to validate this method. Our study consists of three branches: Clinical inspection, X-ray, and the assessment of different outcome protocols and the DASH-score. Evaluation of long-term results according to the different scoring systems showed a high correlation between the AO fracture classification and the final outcome. Excellent or good results were reached in nearly 100% for A-fractures and only 50% for C fractures. Our study show that Kapandji pinning of the distal extraarticular radius fractures proves the gold standard for surgical treatment. However, only few exceptional cases of C-fractures are indications for percutaneous pinning.

The unstable distal radial fracture one year post Kapandji intrafocal pinning

Kapandji pinning has been proposed as the treatment of choice for unstable Colles' fractures. The aim of this paper is to evaluate our experience treating unstable Colles' type fractures using this technique. Over a nine month period, 36 patients with Colles' type fractures were treated operatively at St. Vincent's Hospital. 22 of these fractures were deemed unstable and were treated using percutaneous intrafocal Kapandji pinning. 20 of these patients were recalled for review at a mean of 11.3 month post injury. At this stage the wrist was examined clinically and radiologically. Initial satisfactory correction of deformity was achieved by this technique. Between the time of wire removal and final review, however, there was significant recurrence of dorsal angulation ( P<0.05), but no significant radial shortening on radiographs. The patients had a satisfactory clinical result in spite of these radiological parameters.

Fractures métaphysaires du radius distal : embrochage de Kapandji ou de Py?

The authors report a prospective and randomized study comparing two pinning techniques for fractures of the distal radius. The series compared 42 patients treated by Kapandji's intrafocal pinning (Group I) and 46 patients treated by Py's isoelastic pinning (Group II). Secondary displacement was observed in 7 patients in group I and in 2 patients in Group II. Secondary displacement of K-wire was observed in 6 patients in group I and in no patient in group II. Functional results were analysed according to jakim's criteria. A significant difference was observed between the two groups, for global scores, objectives scores and radiological scores, with better results for Py's pinning. No significant difference was observed for subjective scores advantages of Py's pinning were: stability of isoelastic wires preventing posterior comminution and no need for radioscopic control. Kapandji's pinning is proposed in cases of lower and unstable fractures in teenagers without focal comminution and in T fractures. In the other cases of metaphyseal fractures with posterior displacement, Py's pinning could be proposed.