|Year : 2022 | Volume
| Issue : 1 | Page : 5-8
Evaluation of functional and radiological outcome of five-pin technique in management of distal end radius fractures
Mahendra Solanki, Dev Krishan Sharma, Rakesh Prasad, Mitul Jain
Department of Orthopaedics, M Y Hospital and MGM Medical College, Indore, Madhya Pradesh, India
|Date of Submission||08-Nov-2021|
|Date of Acceptance||25-Dec-2021|
|Date of Web Publication||15-Jun-2022|
Dr. Mitul Jain
91, Radhakrishna Vihar, Pipliyahana, Indore, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Distal end radius fractures are the most common fractures of the upper extremity. The most common mode of injury is a fall on outstretched hand. Closed reduction and percutaneous pinning with “the five-pin technique” improve the reliability of fixation. The current study aimed to assess the clinical and functional outcome of fixation of distal radius fractures using the five-pin technique. Materials and Methods: Thirty patients with fracture of distal end radius Frykman type 1 and 2 were subjected to close reduction and K-wire fixation by five-pin technique. Results: Functional outcome-using Obrien scoring system for functional outcome, there was 90%–100% score in 11 patients, 80%–89% in 18 patients, and <80 in one patient. Radiological outcome-using Sarmiento modification Lindstrom criteria for radiological outcome, 11 patients had excellent results, and 18 had good results, and one had fair results. Conclusion: “The five-pin technique” is a versatile tool which provides optimum functional and radiological outcomes.
Keywords: Distal radius fractures, five-pin technique, K-wire fixation
|How to cite this article:|
Solanki M, Sharma DK, Prasad R, Jain M. Evaluation of functional and radiological outcome of five-pin technique in management of distal end radius fractures. J Orthop Traumatol Rehabil 2022;14:5-8
|How to cite this URL:|
Solanki M, Sharma DK, Prasad R, Jain M. Evaluation of functional and radiological outcome of five-pin technique in management of distal end radius fractures. J Orthop Traumatol Rehabil [serial online] 2022 [cited 2022 Jun 26];14:5-8. Available from: https://www.jotr.in/text.asp?2022/14/1/5/347357
| Introduction|| |
Fracture of the distal radius is the most common of all orthopedic injuries accounting 16%–20% of all fractures presenting to the emergency department. Road traffic accident plays a major role sustain these trauma while older person has house fall with trivial insults. Pathoanatomy and biomechanics of radiocarpal and radioulnar joints have pivotal role in maintaining wrist functions and movement. Problems associated with these fracture hamper strength of grip and early arthritis with carpal instability. Close reduction with cast application is the most common modality of treatment for distal radius fracture. But compications such as fracture malunion and subluxation of distal radioulnar joint is a common complication associated with close reduction with cast application. Although many treatment modalities are available, there is no consensus on the optimum treatment of these injuries.
Aims and objective
evaluation of functional and radiological outcome of five-pin technique in management of distal radius fracture and to study the complication associated with this technique.
| Materials and Methods|| |
Men and women above 50 years of age reporting to emergency/outpatient department with a history of trauma, swelling in wrist were considered for primary and secondary surveys to rule out any other injuries. After diagnosing the fracture, the following patients were included in the study:
- Age above 50 years
- All extra-articular fractures which are reduced by close method or joystick method
- Patient presenting within 7 days of fracture.
The following patients were excluded from the study:
- Patients with intra-articular fracture of distal radius
- Pathological fracture
- Patients with compound fracture
- Patients with associated ipsilateral upper limb trauma
- Uncontrolled diabetes mellitus.
Closed reduction performed using Charnley's method and checked under image intensifier to confirm acceptable reduction and proceed with K-wire fixation in the following order:
- Radial styloid pin in lateral to medial direction
- Medial corner pin in dorsal to volar and medial to lateral direction
- Lister tubercle pin in dorsal to volar direction
- Distal and proximal radio ulnar pins [Figure 1].
|Figure 1: Post operative X-ray of 50 year old male with fryman type 1 fracture|
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Patient was given above-elbow plaster of Paris Slab and prescribed analgesic and antibiotic drugs. Regular pin tract dressing was explained.
Patient was followed up for 1, 3, 6, and 12 weeks. At 3 weeks, above-elbow slab was removed and below-elbow slab was applied, and proximal and distal radioulnar wire was removed [Figure 2]. At the end of 6 weeks, remaining K-wire and below-elbow slab were removed, and physiotherapy was started [Figure 3].
|Figure 2: Follow up X-ray of same patient at 3 weeks with proximal and distal radio ulnar K wires removed|
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|Figure 3: Follow up X-ray of same patient at 12 weeks after removal of all the K wires|
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| Results|| |
Thirty patients with fracture of distal radius were studied prospectively at MGM Medical College, Indore, from September 2019 to August 2021. The sex distribution and fracture type has been mentioned in [Table 1] and [Table 2] respectively.
The mean age of the patients included in the study was 56 years with youngest patient being 50 years and the oldest patient being 80 years.
All patients were operated within 7 days of trauma.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5] shows a case of 50 year old male patient with frykman type 1 fracture that had an uneventful recovery.
|Figure 4: Clinical photo showing functional outcome of same patient at 12 weeks after removal of all the K wires|
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|Figure 5: Pre operative X-ray of 50 year old male with fryman type 1 fracture|
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Complication-superficial pin track infection was reported by one patient that was treated with antibiotics, dressing, and repining.
| Discussion|| |
Fracture distal end radius is second only to hip fracture as the most frequent fragility fractures. The importance of anatomic reduction has been demonstrated by clinical studies as well as laboratory assessment of force and stress loading across the radiocarpal joint. Recent studies done by Bhasme et al. and Vasudevan and Lohith in their series using closed reduction and five-pin technique suggested that using the two additional radioulnar wires can prevent late radial collapse by giving adequate rotational stability. The functional outcome assessed using Green and Obrien scoring is comparable to the studies by Yamamoto et al. (they used external fixator for distal radius fractures) using the same scoring system. In our study, functional outcome using Obrien scoring was found to be 90–100 in 11 patients and 80–89 in 18 patients [Table 3]. Functional parameters and anatomical parameters assessed on the basis of Sarmiento modification of Lidstrom criteria are comparable to the studies by Gruber et al. who used volar plating for fixation of distal radius fracture. Mean palmar flexion 63 ± 15, mean dorsiflexion 82 ± 11, mean supination 82 ± 11, and mean pronation 83 ± 14 in study by Gruber et al. In our study, mean supination at 12 weeks was 72.50 ± 7.86, mean pronation of 64.75 ± 7.51, mean palmar flexion of 77 ± 11.74, and mean dorsiflexion of 65.25 ± 5.49 [Figure 4]. Radiological outcome in our study was found to be excellent in 11 patients and good in 18 patients [Table 4]. In fractures with articular surface displacement >2 mm, radial shortening >5 mm, or dorsal angulation more than 20°, suboptimal results have been reported in previously published studies. Accurate reduction of the fracture is the first step in treatment of distal radius fractures. The most common traditional method is closed reduction and cast immobilization, but this is often fails to prevent early radial collapse and is associated with high risk of malunion, joint stiffness, and painful wrist. Hence, this method is only reserved for low-demand elderly patients. External fixation can maintain radial length and radial inclination by ligamentotaxis but fails to maintain palmar tilt. Furthermore, complication rate as high as 60% has been reported with the use of external fixator. These mainly include pin loosening, pin tract infections, reflex sympathetic dystrophy, radial sensory neuritis, and delayed nounion. Percutaneous pinning is simple, minimally invasive technique that prevents redisplacement of fragments adequately. Therefore, this method is appropriate for elderly patients with severely displaced and unstable fracture of distal radius. The goal of managing distal radius fracture is anatomic reduction, fracture stability, early mobilization, pain-free range of movement, and minimal complications. All mention goals can be achieved using five-pin technique for fixation of distal radius fractures. The five-pin technique carries the advantages of lesser stiffness postoperatively. Another significant advantage of five-pin technique is its ability to prevent fracture collapse and provide rotational stability. Distal radius fractures occur in innumerable patterns; hence, it is important to individualize treatment. This technique helps us achieve a much-desired fragment-specific fixation.
|Table 4: Radiological outcome-using sarmiento modification lindstrom criteria|
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| Conclusion|| |
Five-pin technique of K-wire fixation is a novel technique that provides effective means of treating distal end radius fractures. It is a versatile tool which provides optimum functional and radiological outcomes.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Frykman G. Fracture of the Distal Radius Including Sequelae-Shoulder–Handfinger Syndrome, Disturbance in the Distal Radio-Ulnar Joint and Impairment of Nerve Function: A Clinical and Experimental Study, Acta Orthopaedica Scandinavica, 1967;38:sup108,1-61.
Cooney WP. Fractures of the distal radius. A modern treatment-based classification. Orthop Clin North Am 1993;24:211-6.
Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al.
Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2018;2:e088.
Bhasme V, Shettar V, Battur M. Functional outcome analysis of fixation of distal radius fractures using “Five Pin Technique”. Int J Contemp Med Res 2018;5:114-8.
Yamamoto K, Masaoka T, Shishido T, Imakiire A. Clinical results of external fixation for unstable Colles' fractures. Hand Surg 2003;8:193-200.
Gruber G, Gerald G, Gruber K, Clar H, Zacherl M, Fuerst F, et al.
Volar plate fixation of AO type C2 and C3 distal radius fractures, a single-center study of 55 patients. J Orthop Trauma 2008;22:467-72.
Sarmiento A, Pratt GW, Berry NC, Sinclair WF. Colles' fractures. Functional bracing in supination. J Bone Joint Surg Am 1975;57:311-7.
Anakwe R, Khan L, Cook R, McEachan J. Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction. J Orthop Surg Res 2010;5:51.
Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am 2009;91:1568-77.
Anand K, Acharya H, Patel S. External fixator and K wire – A versatile tool in distal end radius fractures. Indian J Orthop Surg 2018;4:48-52.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4]