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Threaded Pin and Volar Plate Fixation of Distal Radius Fractures: Early Functional Recovery
Justin Vaida, MD1, Patrick Luchini, MD1, Julie Glener, MD1, Michael W Kessler, MD2, Lucy McCabe, BS3 and John P. Taras, BS1, (1)West Virginia University, Morgantown, WV, (2)Medstar Georgetown University Hospital, Washington, DC, (3)The Philadelphia Hand Center, Philadelphia, PA

INTRODUCTION
Open reduction and internal fixation (ORIF) of distal radius fractures (DRF) maintains reduction and allows an early wrist motion program, which has been associated with earlier functional recovery. Locked volar plates (VP) require an invasive approach and can cause tendon irritation or attrition. This study compares threaded distal radius pin (TDRP) fixation, a lower cost and minimally invasive approach, to VP fixation of extra-articular DRFs.

METHODS
A prospective, nonrandomized evaluation of patients undergoing operative fixation of isolated extra-articular DRFs and subsequent postoperative therapy was performed. Clinical variables included implant type and assessment of volar tilt, radial height, postoperative wrist flexion, extension, pronation, supination, key pinch, and grip strength. The number and duration of therapy visits was also recorded.

RESULTS
A total of 43 patients (21 TDRP, 22 VP) were identified (mean age 46.3 TDRP, 53.7 years VP) with mean follow-up duration of 7.4 months. Pre- and postoperative radiographic parameters were statistically similar for both groups with both groups maintaining reduction. There were no statistically significant differences for postoperative range of motion, pinch strength, or grip strength at the time of discharge from therapy. The average number of postoperative therapy visits was 10.8 for the TDRP (mean 68 days) and 17.2 for the VP group (mean 132 days), a difference of 64 days. 20% of the VP cases required hardware removal while no threaded pins required removal.

DISCUSSION AND CONCLUSION
Patients with extra-articular DRFs treated with threaded pins achieved similar radiographic and functional outcomes compared to patients treated with volar locking plates, while recovering significantly more quickly and requiring less postoperative hand therapy. In the appropriately selected patient, threaded pins provide a less invasive, lower cost fixation method enabling a significantly reduced recovery period.


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