Comminuted fracture and volar carpal malalignment increase rate of late displacement in distal radius fracture treated with percutaneous pinning.
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Abstract
Background: Closed reduction and percutaneous pinning is an accepted method in treating distal radius fractures, due to shorter operative time and economic advantage. Fixation with Kirschner wire gives lower stability compared to plate and screws and may result in displacement of fracture during follow-up period.
Objective: To describe the incidence and explore what risk factors can predict late instability of distal radius fracture treated with Kirschner wire fixation.
METHODS: All cases of closed distal radius fractures treated with closed reduction and percutaneous pinning in Chiangrai Prachanukroh hospital in the year of 2018 to 2020 were retrospectively reviewed. Patients’ data, preoperative, immediate postoperative and 4-8 weeks postoperative radiographic parameters were compared. The patients were divided into late displacement group and stable group at the end of treatment and risk factor of late displacement was calculated.
RESULTS: In 380 cases of distal radius fractures after percutaneous pinning, 89 cases had a late displacement of fracture. The rate of displacement was 23.42%. Multivariable analysis showed comminuted fracture patterns and volar carpal malalignments are the risk factors which increased the rate of late displacement. Using 3 K-wires significantly prevented the displacement rate compared to 2 k-wires.
CONCLUSIONS: Volar carpal malalignment or comminuted fracture increased displacement rate of percutaneous pinning in distal radius fracture. Open reduction with plate and screws fixation should be considered for the operative treatment in such cases. If percutaneous pinning was chosen, fixation with 3 K-wires may prevent late displacement.
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References
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