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

doi:10.4103/jotr.jotr_113_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 14 | 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

Correspondence Address:
Dr. Mitul Jain
91, Radhakrishna Vihar, Pipliyahana, Indore, Madhya Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jotr.jotr_113_21

Abstract

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 2023 Apr 1];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.^[1] 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.^[2] 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

Inclusion criteria

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.

Exclusion criteria

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.

Table 1: Sex distribution

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Table 2: Fracture type distribution

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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.^[3] 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.^[4] 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.^[5] 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.^[6] 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.^[7] 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.^[8] 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.^[9] 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.^[10] 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 3: Functional outcome using Obrien scoring

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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

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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