Unstable extra-articular fractures of the distal radius : A prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning

• Published in: Journal of bone and joint surgery. British volume Vol. 87; no. 6; pp. 837 - 840
• Main Authors: AZZOPARDI, T, EHRENDORFER, S, COULTON, T, ABELA, M
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.06.2005; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Biological and medical sciences; Bone Wires; Casts, Surgical; Diseases of the osteoarticular system; Female; Fracture Fixation - methods; Hand Strength; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Orthopedic surgery; Postoperative Complications; Prospective Studies; Radius Fractures - surgery; Range of Motion, Articular; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; Treatment Outcome; Wrist Injuries - surgery; Radius; Orthopedic surgery; Treatment; Distal; Orthopedics; Diseases of the osteoarticular system; Rheumatology; Fracture; Trauma; Anchoring; Comparative study; Percutaneous route
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.87B6.15608

We performed a prospective, randomised study on 57 patients older than 60 years of age with unstable, extra-articular fractures of the distal radius to compare the outcome of immobilisation in a cast alone with that using supplementary, percutaneous pinning. Patients treated by percutaneous wires had a statistically significant improvement in dorsal angulation (mean 7 degrees), radial length (mean 3 mm) and radial inclination (mean 3 mm) at one year. However, there was no significant difference in functional outcome in terms of pain, range of movement, grip strength, activities of daily living and the SF-36 score except for an improved range of movement in ulnar deviation in the percutaneous wire group. One patient developed a pin-track infection which required removal of the wires at two weeks. We conclude that percutaneous pinning of unstable, extra-articular fractures of the distal radius provides only a marginal improvement in the radiological parameters compared with immobilisation in a cast alone. This does not correlate with an improved functional outcome in a low-demand, elderly population.