Management of distal radius fractures - A new concept of closed reduction and standardised percutaneous 5-pin fixation

Introduction: Management of distal radial fractures is a controversial topic, with poor reported outcomes in up to 30% of cases and a wide variety of treatment options such as closed reduction and POP cast, internal fixation, external fixation and percutaneous pin fixation in many configurations. Over the last 13 years, we have used a novel standardised 5-pin configuration of percutaneous K-wire fixation, which can be used in most types of distal radial fractures, where closed reduction is possible, and the ulna is intact or re-constructible. This study reports the outcomes of this technique. Methods: All patients presenting to our unit with distal radial fracture in a 126-month period from June 2005 to December 2015 managed by closed reduction and 5-pin fixation were evaluated for complications including wire loosening and infection, tendon or nerve injury, reflex sympathetic dystrophy and functional outcome. Results: A total of 490 consecutive patients with 496 distal radial fractures were treated in the study period with a mean age of 49.4 years; 57% were female and 57% were due to domestic falls. After death from unrelated causes and loss to follow-up, 418 patients were reviewed in clinic, and a further 40 were patients contacted by telephone at one year, and clinical outcome was evaluated using Cooney's modification of Green and O'Brien's score. All fractures healed and 95.7% had an 'excellent' outcome and 3.9% were 'good'; only two patients achieved a 'fair' outcome, both of whom had comminuted intra-articular fractures with metaphyseal comminution. Complications were minimal and temporary with no cases of deep infection, tendon or nerve injury or reflex sympathetic dystrophy. Conclusions: This study proved that our novel customised 5-pin percutaneous fixation was sufficiently stable and controlled all fragments of distal radial fractures effectively to allow early mobilisations to prevent stiffness and reflex sympathetic dystrophy with excellent functional outcomes.