Hand Surgery

Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures. Glickel SZ, Catalano LW, Raia FJ, Barron OA, Grabow R, Chia B. J Hand Surg Am. 2008;33:1700–1705. Context: There are several ways to treat distal radius fractures including casting, closed reduction with percutaneous pinning, and open reduction internal fixation. Pinning can be a relatively simple and minimally invasive treatment option for twoand three-part distal radius fractures. Study Design and Results: A retrospective review was performed involving 54 patients with 55 distal radius fractures (AO types A2, A3, C1, or C2) treated with closed reduction percutaneous pinning. The average followup for this group of patients was 59 months. Range of motion was compared with that of the contralateral hand. Forearm supination (4 ) and wrist flexion (5 ) were decreased compared with those of the normal wrist. The DASH (Disability Arm Shoulder and Hand) scores averaged 9.7, which approximates the mean values of healthy volunteers as reported by Hunsaker et al. A change in ulnar variance was seen in six of 55 wrists between immediate postoperative and final followup radiographs. Three patients had increased articular step-off on final followup. Four patients had lost 5 or greater volar tilt and had dorsal angulation. Conclusions: Closed reduction and percutaneous pinning of twoand three-part distal radius fractures seem to provide acceptable long-term clinical results. Comments: Percutaneous pinning has been criticized because it is said to not sustain the immediate postoperative reduction, and the fracture tends to settle during initial healing. A benefit of this procedure is relative decreased cost, as K-wires can cost approximately $23 (US). Pearls: Retrospective studies such as this one can at best prove that the treatment under consideration is acceptable, not necessarily preferable to another (as it was not studied head-to-head).