PERCUTANEOUS PINNING OF INTRA ARTICULAR FRACTURES OF DISTAL RADIUS

Abstract

A prospective study to examine the outcome of closed fixation technique in managing the unstable, intra-articular fractures of the distal radius by using k-wires only is undertaken.

Sixty-two wrists with unstable distal radius fractures were treated with closed manipulation and closed pinning of the fracture. Ten are between fifty-one and eighty-one years old and fifty-two are below fifty years of age. Both readial styloid and the dorsal cortex of the distal fragment provided the entry points. All fractures were reduced with fingfer trap traction. Tran osseous and intra-medulaary pinning was carried out in all the fractures. In this two step technique, first the radial articular surface is stabilised. Then, axial stability is provided by trans-epiphyseal intramedullary nails. Emphasis was laid on the reduction, complications and fracture healing.

All fractures healed. A ‘concentric’ collapse varying from 1 to 3 mm was seen in twenty-six cases. No loss of reduction was seen. Surprisingly, no cutaneous radial nerve injuries, no tendon related complications were seen. Five pins in three patients were loose and were removed betweeen seven to thirty days. None had repeat surgeries.

Sound technique is key to success. The longer the collective length of the intra- medullary pins the greater remained the stability of the fracture construct. Ulnar bone provides as a pillar to assemble the distal radius. Fracture of the distal ulna (not merely a fracure of the ulnar styloid) required an additional support in the form of an external fixator in only two patients. Since the follow-up is not very long (mean six months), the author contends to say that the short term results are rewarding with this technique. The unsatisfactory results reported in literature from the closed pinning is largely from inadequate fixations used. When proper technique is applied the radial articular surface is held on the distal shaft to permit only a minimal collapse that is concentric; and compression at the fracture site promoting excellent healing is the rewarding result.