Distal Radius Fractures: Functional and Financial Evaluation of Closed Reduction and Percutaneous Kirschner Wire Pinning
Ritsaart Frederik Westenberg, MD; Sezai Özkan, MD; Lydia Helliwell, MD; Chaitanya S. Mudgal, MD
Massachusetts General Hospital, Boston, MA
Introduction. Closed reduction and percutaneous pinning (CRPP) is relatively unpopular compared to treatment of distal radius fractures by ORIF. We aimed to retrospectively assess the outcomes after closed reduction and percutaneous Kirschner wire pinning for the treatment of distal radius fractures and to compare these with the results of previous studies.
Methods. We used billing records to identify all skeletally mature patients with a distal radius fracture who were treated with closed reduction and percutaneous Kirschner wire pinning by a single surgeon at a level I trauma center in an urban city in the United States from 2012 to 2016. We included 34 patients in this study with a mean age of 47 ± 18 years (range 22 - 85 years). Eighty-two percent (n=28) were female and the majority of the patients (n=25; 74%) had an AO-Muller type C fracture. The mean duration of follow-up was 19 weeks (range 6 - 89 weeks). We manually assessed the charts, operative reports and radiographs of each of these patients and recorded basic demographics, trauma characteristics, treatment characteristics, and outcomes. We measured radiographic parameters of the radius fractures on the pre-reduction and the final follow-up radiographs.
Results. Radiographic evaluation of the final follow-up radiographs showed a 32% improvement of the average radial height and a mean difference of 19ˇ of palmar tilt (Table 1). Over 80% of the patients demonstrated a good or excellent range of motion in terms of flexion/extension of the wrist and all patients had a good or excellent range of motion in terms of forearm rotation (Table 2). Two patients had post-operative complications: pin tract infection and subcutaneous migration of the radial pin, which were treated through pin removal. Looking at material costs only, ORIF of distal radius fractures are 162.5 times more expensive than CRPP ($1625,- vs $10,-).
Conclusion. In selected cases, CRPP of distal radius fractures is a fast and remarkably cheaper alternative to treatment by means of ORIF. The outcomes after CRPP are satisfactory for carefully selected type A or C fractures
Level of evidence. Prognostic level II
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