Is percutaneous pinning an outdated technique for distal radius fractures?

Abstract

Distal radius fracture is a very common injury representing 17.5% of all fractures seen in the emergency room. However, the most effective treatment is still unclear and controversially debated. For ten years, we have been facing a true revolution by the increasing use of open reduction and fixation by volar locking plates as an alternative to previous less invasive treatment such as closed reduction and percutaneous k-wire pinning. Several meta-analyses have compared the clinical results after closed reduction and percutaneous pinning and volar locking plate fixation. Volar locking plate fixation achieves better early functional recovery, better radiological outcomes and less minor complications. However, long-term results were similar for both fixation methods. In addition, worse radiological outcomes and more minor complications after closed reduction and percutaneous pinning seem not to be clinically relevant. Interestingly, volar locking plate fixation continues to be a more dominant treatment method compared to percutaneous pinning in operative care of distal radius fractures. Surgeon characteristics such as age, profession as well as location and type of the clinic seem to play a role in the decision for the surgical treatment method. It appears that implant cost plays a minor role in treatment choice between closed reduction and percutaneous pinning and volar locking plate fixation.

Keywords: Distal radius fracture; Kapandji’s technique; Percutaneous pinning; Volar locking plate; Wrist fracture.