Fractures of the Distal Radius - Punjab Orthopaedic Association

Pb Journal of Orthopaedics Vol-X, No. 1, 2008
Fractures of the Distal Radius: Current Concepts
37
The pins-and-plaster technique, although appealing in
concept, it is often difficult in practice. Application of the
plaster around the pins may prolong the procedure
sufficiently to prevent adequate molding of the cast.
Subsequent dorsal redisplacement and angulation of the distal
fragment has been one reason that the pins-and-plaster
19-22
technique is now infrequently used .
23-28
Percutaneous pinning
Various configurations of percutaneously placed pins
have been advocated for the stabilization of distal radius
fractures. This technique has been used for displaced extraarticular
fractures with or without dorsal comminution, early
loss of reduction after closed manipulation, and comminuted
intra-articular fractures when adequate closed reduction is
able to be obtained but likely not maintained without
additional support.
Percutaneous pin fixation is an excellent technique (Fig
2), provided that the distal aspect of the radius is not severely
comminuted or osteoporotic, because the trabecular bone of
the metaphysis provides little inherent stability. A variety of
different techniques have been described in the literature.
Kirschner wires can be placed through the radial styloid
(trans-styloid), within the fracture site (intrafocal), into distal
fragments to aid in reduction, and across the distal radioulnar
joint for treatment of gross instability of the distal radioulnar
joint. Another method of percutaneous pin fixation is the
intrafocal pin technique of Kapandji, which is best reserved
for noncomminuted extraarticular fractures In this technique,
the Kirschner wires are introduced into the fracture site itself,
rather than through the distal fracture fragment. With severe
comminution in both the articular and the metaphyseal
region, a combination of percutaneous pins, internal fixation,
and external fixation is frequently required in order to
maintain reduction. (Fig 3)
Pins that are used for less than 6 weeks are left protruding
from the skin. Pins that are to be left in place longer than 6
5
weeks are buried .
Fig. 3
Fig. 4
Fig. 2
29-39
External Fixation
An external fixation device is often an important part of the
treatment of fractures of the distal radius. In many instances of
severe comminution of the metaphysis, the surgeon can
reconstruct the articular surface but cannot stabilize it to the
shaft of the radius. An external fixation device can allow