Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age

Objective: To compare the results of treating unstable distal radius fractures either by percutaneous pinning and casting, or by traditional closed reduction and casting. Design: Prospective, randomized. Setting: University hospital. Patients: Forty patients with unstable Frykmann III-VIII distal radius fractures resulting from a fall. Interventions: Twenty patients were treated with closed reduction, consisting of manipulation, under local anesthesia, followed by casting. Twenty patients were treated with percutaneous fixation using K-wires, followed by casting. Main Outcome Measurements: Initial displacement, quality of reduction, carpal malalignment, articular step-off. Range of motion and grip Strength were measured using a scoring system reported by Home et al. (10). Results: Functional results in the pinning group were better (excellent, 12; good, 6; fair, 2) than in the plaster group (excellent, 3; good, 8; fair, 5; poor, 4). Anatomic results also were better in the pinning group. Conclusion: The best anatomic and functional results were obtained by percutaneous pinning. Although the cost of pins and plaster treatment is significantly greater than plaster treatment, the author believes that the positive end result justifies the cost.